2011 Summer Camp

Name (English):
日本語名:
	Boy
	Girl
Age (as of first day of your camp session):
Date of Birth(mm/dd/yyyy):
What grade (current school year)?
Current Japanese School Information (select all that apply - hold Ctrl key to select)：
Home Language(s)（家庭での言語）English ?% Japanese ?% Other language ?%：
Years lived in Japan(日本滞在年数）：
Any food allergies & restrictions （日本語可）:
Any other health issues or any additional information(日本語可)：
Any requests for grouping (not guaranteed)
Primary Guardian`s Name （保護者氏名）*：
Secondary Guardian:
Home Phone number:
Home Address*:
Cell Phone number*:
E-mail address*:
	English Only
Emergency Contact（緊急連絡先）*　Please provide name, phone number, and the relationship to the camper：
Please select the plan from below. If you choose a Partial Plan, please provide here which days you are attending:
	Session 1 Package Plan
	Session 1 Without Sleepover
	Session 1 Partial Plan
	Session 2 Package Plan
	Session 2 Without Sleepover
	Session 2 Partial Plan
Payment Option (how would you like to pay?):
How did you hear about this camp?:

日本語での入力可。