!!!!!!!!1++"/($'/,2&3,-4 KAIS International School 2-7-16 Kami-Osaki, Shinagawa-ku, Tokyo 141-0021, Japan Tel/Fax: +81-(3)-5421-0127
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Student Information: PLEASE PRINT LEGIBLY IN BLOCK LETTERS Student Name: _______________________ _________________________ _____________________ Family Name First Name Middle Name
Grade for which your child is applying: ____________ Planned date of entry into KAIS: ________________________________ Birth date (mm/dd/yy): ____________________ Age: ________ Sex: Male / Female Religion: _____________________ Country of Birth: _________________________ Citizenship: ______________________ Passport No.: __________________ Student’s Email: ________________________________ Student’s Cellphone #: __________________________________
Schools Attended: Please begin with present school and list all schools your child has attended. Name of School
City/Country
Language of Instruction
Years attended
Grade completed
To
To
To
Family Information: FATHER Last, First & Middle Name:
MOTHER Last, First & Middle Name:
Nationality:
Nationality:
Country of Birth:
Country of Birth:
Employer:
Employer:
Position/Title:
Position/Title:
Address of the employer (in English):
Address of the employer (in English):
Location
Telephone Number
Mobile Phone Number
Email Address
Home Address
Home: Work (father): Work (mother):
Other children in the Family: Name
Age
Sex
Current School