Student’s registration form

Please fill in the * mark

Name (kanji / alphabet) *
Name (katakana)
Gender *	MaleFemaleI don't want to answer
Birthdate *	Month: Day: Year:
Postal number
Home Address *
Telephone no.
E-Mail address *
Home Country *
Mother tongue *
Number of participants (up to 3 people including the representative) *

2nd participants
Name (kanji / alphabet) *
Name (katakana)
Gender *	MaleFemaleI don't want to answer
Birthdate *	Month: Day: Year:
Telephone no.
E-Mail address *
Home Country *
Mother tongue *

3rd participants
Name (kanji / alphabet) *
Name (katakana)
Gender *	MaleFemaleI don't want to answer
Birthdate *	Month: Day: Year:
Telephone no.
E-Mail address *
Home Country *
Mother tongue *

Desired day and time (Allowed multiple answer) *

Disired location (Allowed multiple answers) *

a. At homeb. Public facilities near your house or where you work (Except your house)c. Online (online conference will use the system ZOOM)

Do you have parking lot ? *
YesNo

Address, facility name

Those who wish to study online must agree to all of 1-3. *	Please prepare your own smartphone or computer ↑ Yes, I understand Please prepare your own internet invironment ↑ Yes, I understand You cannot record what you are studying ↑ Yes, I understand

Reason you cannot attend a regular Japanese language school (Multiple answers allowed) *	a. No Japanese language schools near my homeb. My day off schedule does not match the Japanese class schedulec. No means of transportation to language schoold. Others
Japanese ability *	a. Cannot speakb. Can speak basic greetings / vocabularyc. Simple conversation
If you have any other requests, please free to write

This course is for learning simple conversation in Japanese. This course is not for those who have more abilities or want to study grammar and kanji. Please put a check if you agree with this agreement.
This course is for adults. Please check if you agree with this.
We will contact you by email or phone within a week. If you do not recieve a call, please contact SIC. Please check if you agree.