English Adventure

Summer Camp Application Form

NAME(English/romaji） 　(Required field)

Gender	Male	Birthdate		Day Year	Grade
	Female	Age	years old	(Required fields)

Parent or guardian's name (Required field)

Postal code - (Required field)

Address in Japanese (Required field)

Address in romaji (Required field)

Telephone number 1 (Required field) Telephone number 2
Mobile phone number (for any urgent contact) (Required field)

Email address (Required field)

Please answer the following questions about your child.

Q1. Does your child have any health problems or conditions that we should know about?

Q2. Does your child regularly take any medications? YES NO
　　　If you answered yes, will your child need this medication during the camp or event? YES NO

Q3. If your child has any allergies, please describe them below.

Food
Medicine
Other

Q4. Are there any activities that you do not wish your child to participate in during the camp or event?
　　　　　 YES NO

　　　　　If you answered yes, please explain below.
　　　

Q5. If you have any other comments or questions, please enter them below.

Please select from the following: (Required field)
English Immersion Course
English Beginners' Course

Please select the camp. You may check more than one box.　(Required field)
7/24-28 Chichibu [A]
8/5-8 Izu-Oshima[B]
8/18-22 Chichibu [B] NOTE: This camp is currently full and we have begun a waiting list. If cancellations occur, we will notify applicants in the order that applications were received.

Privacy policy: English Adventure will only use your information for
purposes directly related to our events and operations. We will never share
your information with any outside parties without your consent.

● Applications are accepted in the order received, and registration will end early if the maximum group size is reached.

● After processing your application, we will send all necessary payment information via the contact method you requested above.

● Camp fees must be sent by the payment deadline, or your registration may be cancelled.

● Camp cancellation policy: 100% refund up to 3 weeks before the start of camp, 50% refund 11-20 days prior to the start of camp. 100% cancellation charge from 10 days prior until the beginning of camp.

● All participants' images may be used in English Adventure's website and promotional materials including print and video.

● Please apply only after reading and agreeing with the above policies.

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