2011 Registration Form

Summer Camp Registration Form

Email address*

Re-enter Email address
Parent's Name*
Postal Code
Address*
Emergency
contact info.*		 phone*
cell phone
cell e-mail address
Camper's name*

English*

Kanji if applies
Sex*
Date of Birth* e.g. 2000/01/23
School Grade e.g. 2nd Grade
School*
Sessions* Sessions in Izu ---

Sessions in Kiyosato ---
Chartered bus* Will you be going to the camp by the bus chartered by SCOA?

(There will be an additional charge for the chartered bus. The bus will leave from Shinjuku.)
Sports* Which sports activity do you want to participate in?
Experience Do you have any experience in flag football or cheer dance?
(Please check)

*Please write how many years of experience you have
e.g. 2 years and 3 months
English proficiency*
T-shirt size* Kid size (cm)　
Adult size
Medication* Can SCOA administer medicine (e.g., pain killer or fever reducer) to your child if (s)he gets hurt or sick during the camp?

(Medicines SCOA will administer are commercially available Japanese medicines.)
Health alert Please describe any preexisting condition or allergy that SCOA staff should be aware of:
Questionnaire*

How did you hear about SCOA?

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confirm the contents*
     

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