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日本語教室保育の申込み票 Application for Japanese Class Childcare Service
Unless you receive an automagical confirmation by return, please check your mail address below again.
After your application duly received, we will contact you within a week for detailed)
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* Indicates required question
Email
*
Your email
PUT YOUR MAIL ADDRESS ABOVE(@メールアドレス) FOR RECEIVING CONFIRAMATION
学習者の名前 / Your Name (FAMILY NAME Given name)
*
Your answer
電話番号 / Tel Number
*
Your answer
出身国・地域 / Country or Region of Origin
*
日本 /Japan/日本
中国 /Chaina/中国
ベトナム / Vietnam/越南
フィリピン / Philippines/菲律宾
韓国 / Korea / 韩国
台湾 / Taiwan/台湾
インド / India/印度
タイ / Thailand/泰国
アメリカ / U.S./美国
ネパール / Nepal/尼泊尔
そのた / others /其它
Other:
Required
対応言語 / Preferred Language
*
Your answer
子どもの名前 / Child Name
*
Your answer
子どもの生年月日 / Child Date of Birth
*
MM
/
DD
/
YYYY
子どもの性別/Child Gender
*
男/Boy
女/Girl
Required
希望曜日/ Prefered Day of the Week
*
月曜日 Monday Only
木曜日 Thursday Only
どちらでも Either Mon. or Thu. is OK
Required
A copy of your responses will be emailed to the address you provided.
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