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長野キャンパスサマープログラム（プレスクール）申込フォーム
This is the application form for Nagano Campus Summer Program (Preschool)
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* Indicates required question
参加児童について（About your child)
氏名（漢字）Name (Kanji)
*
If there is no Japanese characters for your child name, please write in English
Your answer
氏名（ふりがな）Furigana
*
Your answer
氏名（英語表記）Name in English
*
Your answer
生年月日（DOB)
*
MM
/
DD
/
YYYY
在籍する園名（Current school attending)
*
Your answer
現在の在籍学年（Current grade)
*
小学2年生(Grade 2)
小学3年生(Grade 3)
住所 (Address)
*
Your answer
アレルギーはありますか (Does your child have allergy?)
*
Choose
ある / YES
ない / NO
ある場合 / Answered YES...
具体的なアレルギー原因や起こりやすい症状・対処法等ご記入ください
Please describe the specific cause, symptoms and treatment.
Your answer
今まで熱性けいれんやひきつけにかかったことはありますか？
*
Have you ever suffered from febrile convulsions or convulsions?
熱性けいれん / febrile convulsions
てんかん / convulsions
Other:
Required
常備薬はありますか
*
Does your child need to take regular medicines?
Choose
はい / YES
いいえ / NO
はいの場合 / Answered YES...
具体的な常備薬とどのようなサポートが必要ですか
What specific regular medicines and what support do you need?
Your answer
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