Everest International School, Japan
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High Goals for Education
New Student Admission Application Form
Name of the Student *
Grade of Enrollment *
Visa Status *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Gender *
Blood Group
Nationality *
Address Details in Japan
Prefecture *
Ward/City *
Example: Suginami - Ku
PO BOX Number *
Example: 1670051
District/Place *
Example: Ogikubo
Street Address *
Example: 2-3-4
Building Name
Example: EISJ Building
Room Number *
Example: 203
Address in Nepal
Province *
District *
Municipality *
Street Address *
House Number
English Language Skills of the Student
Read
Clear selection
Write
Clear selection
Speak
Clear selection
Understand
Clear selection
Guardian's Information
Father' Name *
Father' Contact Number *
Mother' Name *
Mother' Contact Number *
Emergency Contact Information
This information should be other than that of the guardian's.
Emergency Contact Name *
Emergency Contact Person' Phone Number *
Relationship with the Student *
Academic Background of the Student
Previous (Last) School' Name
Grade Completed
Medical History of the Student
Has your child been treated for any serious medical issue in the past? *
If yes, please provide the details of the condition.
Does your child have any medical problems now? *
If yes, please provide the details of the condition.
Name of the applying Guardian *
The information provided here are true and correct to my knowledge. *
Required
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