Kinder/Grade Registration

Kinder/Grade Registration
New/Returning Student *
Child Info
Full Name *

First Name Last Name
お名前 *

名性
Date of Birth *

- Month - Day Year
Date

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Current School *
Current Grade
Parent/Guardian Info 1
Name *

First Name Last Name
Cell Phone *

- Area Code Phone Number
Email *
Parent/Guardian Info 2
Name *

First Name Last Name
Cell Phone *

- Area Code Phone Number
Email *
example@example.com
For New Students:
Why do you want your child to attend our center? (お子様を当校に入学させたいと思われた理由をお書きください）
Payment
Payment Breakdown:

{newreturningStudent}

Registration Fee ($45)
Total Fee *

Total Fee (all fees are non-refundable) *

USD Total Cost

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

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