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Pupil’s Information 1
Pupil’s Name※	First Name Last Name
Name he/she is known by
Pupil’s Date of Birth※
Pupil’s Gender※	BoyGirl
Nationality/ies ※	Nationality 1※ Nationality 2
First Language※
Other Languages
Intended Date of Entry to JINIS※
Intended Length of Stay※
Name and Location of Current and Previous Schools
Pupil’s Medical Information 1
Please give any medical information that is relevant to your child's full participation in school life.
Please indicate any Allergies/Sensitivities your child has
Dietary/Religious restrictions
Does your child require any regular medication or other special measures to be taken with regards to health? ※	NoYes
Does your child have any siblings?※	YesNo
Pupil’s Information 2	Delete Pupil’s
Pupil’s Name※	First Name Last Name
Name he/she is known by
Pupil’s Date of Birth※
Pupil’s Gender※	BoyGirl
Nationality/ies※	Nationality 1※ Nationality 2
First Language※
Other Languages
Intended Date of Entry to JINIS※
Intended Length of Stay※
Name and Location of Current and Previous Schools
Pupil’s Medical Information 2
Please give any medical information that is relevant to your child's full participation in school life.
Please indicate any Allergies/Sensitivities your child has
Dietary/Religious restrictions
Does your child require any regular medication or other special measures to be taken with regards to health? ※	NoYes
Does your child have any siblings?※	YesNo
Pupil’s Information 3	Delete Pupil’s 3
Pupil’s Name※	First Name Last Name
Name he/she is known by
Pupil’s Date of Birth※
Pupil’s Gender※	BoyGirl
Nationality/ies※	Nationality 1※ Nationality 2
First Language※
Other Languages
Intended Date of Entry to JINIS※
Intended Length of Stay※
Name and Location of Current and Previous Schools
Pupil’s Medical Information 3
Please give any medical information that is relevant to your child's full participation in school life.
Please indicate any Allergies/Sensitivities your child has
Dietary/Religious restrictions
Does your child require any regular medication or other special measures to be taken with regards to health? ※	NoYes
Does your child have any siblings?※	YesNo
Pupil’s Information 4	Delete Pupil’s 4
Pupil’s Name※	First Name Last Name
Name he/she is known by
Pupil’s Date of Birth※
Pupil’s Gender※	BoyGirl
Nationality/ies※	Nationality 1※ Nationality 2
First Language※
Other Languages
Intended Date of Entry to JINIS※
Intended Length of Stay※
Name and Location of Current and Previous Schools
Pupil’s Medical Information 4
Please give any medical information that is relevant to your child's full participation in school life.
Please indicate any Allergies/Sensitivities your child has
Dietary/Religious restrictions
Does your child require any regular medication or other special measures to be taken with regards to health? ※	NoYes
Does your child have any siblings?※	YesNo
Pupil’s Information 5	Delete Pupil’s 5
Pupil’s Name※	First Name Last Name
Name he/she is known by
Pupil’s Date of Birth※
Pupil’s Gender※	BoyGirl
Nationality/ies※	Nationality 1※ Nationality 2
First Language※
Other Languages
Intended Date of Entry to JINIS※
Intended Length of Stay※
Name and Location of Current and Previous Schools
Pupil’s Medical Information 5
Please give any medical information that is relevant to your child's full participation in school life.
Please indicate any Allergies/Sensitivities your child has
Dietary/Religious restrictions
Does your child require any regular medication or other special measures to be taken with regards to health? ※	NoYes
Registered person Information
Name of primary contact person※	First Name Last Name
Contact email address※
Confirm contact email address※
Parent's Information
Parent / Guardian 1※	First Name Last Name Nationality Language EnglishJapanese Mobile Phone Email address Employer
Parent / Guardian 2※	First Name Last Name Nationality Language EnglishJapanese Mobile Phone Email address Employer
With whom does the applicant live? (parents, father, mother, guardian, etc.)
Who will be paying the tuition fees?
Where did you hear about JINIS?
I have read and agree to the terms and conditions of the school ※	Yes