*Name of Child

*Date of Birth

*Biological Gender
FemaleMale

Program(s) of Interest to You

Discovery Courses

PreschoolGrads (Elementary School Students)Teens (Junior High School Students)7/24-28 Summer School 'Our Home, Planet Earth' (Elementary students)7/31-8/4 Summer School 'Art Attack' (Preschool students8/14-18 Summer School 'Alphabet Adventure' (Preschool students)8/21-25 Summer School 'Art Attack' (Elementary students)7/25 Mommy & Me Baby ClassOther

Parent/Guardian Information

*Name

*Relation to Child

*Email Address

*Confirm Email Address

*Telephone Number

Home Address

*Postal Code

*Prefecture
HokkaidoAomoriIwateMiyazakiAkitaYamagataFukushimaIbarakiTochigiGunmaSaitamaChibaTokyoKanagawaNiigataToyamaIshikawaFukuiYamanashiNaganoGifuShizuokaAichiMieShigaKyotoOsakaHyogoNaraWakayamaTottoriShimaneOkayamaHiroshimaYamaguchiTokushimaKagawaAisaiKochiFukuokaSagaNagasakiKumamotoOitaMiyazakiKagoshimaOkinawaOutside Japan

*City

*Address Line 1

Address Line 2

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Comments / Questions

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