Summer Program Application

for NIS Students

Forms

Required

 2022 Summer Session: August 1 (Mon) - August 5 (Fri)

Student Information

Namerequired
First Name
Nickname (optional)
Last Name
Gender
Must contain a date in M/D/YYYY format
Current Schoolrequired
Age GrouprequiredWe are sorry, but Group C has reached its capacity and is no longer available.
We are sorry, but Group C has reached its capacity and is no longer available.

School History

Language of Curriculumrequired
Name of School as of September 2022required
Language of Curriculumrequired
Previous School (only Full Time Schools)
Name of the School (full time, English based)
Add Schoolrequired
Spoken English Levelrequired5=Fluent 3=Communicate with effort 1=Limited
5=Fluent 3=Communicate with effort 1=Limited
Reason of Application (Please pick all that apply)required

Student Health History

1. Is the student currently being treated for a medical condition?required
Does the condition require intervention at school?required
2. Does the student have an ongoing illness, injury or physical challenge (or a past history) that could affect program participation?required
3. Does the student take any prescribe medication on a regular basis?required
4. Does the student have any vision or hearing concern?required(i.e. difficulty seeing. crossed/reddened/watery eyes, uses hearing aid, etc.)
(i.e. difficulty seeing. crossed/reddened/watery eyes, uses hearing aid, etc.)
5. The student has a SEVERE, life threatening allergy diagnosed by a physician.required
Does the condition require medication?required
6. The student has an allergy diagnosed by a physician that is NOT life threatening.required
Does the condition require medication?required
7. Do you have concerns about the physical health of the student?required(eating/sleeping habits, bowel or bladder, teeth, skin, menstruation, weight etc.)
(eating/sleeping habits, bowel or bladder, teeth, skin, menstruation, weight etc.)
8. Is the student currently covered by the Japanese Health Insurance Plan? required(日本の健康保険証をお持ちですか?)
(日本の健康保険証をお持ちですか?)

If your family is covered by the Japanese Health Insurance plan, please send the copy of the plan to summerprogram@nis.ac.jp 

日本の健康保険証をお持ちの場合は、コピーをsummerprogram@nis.ac.jp までお送りください。

Family Information

Parent /Guardian 1 (Primary Contact)required
First Name
Last Name
Primary Contact Phone Number
Primary Email Address
Relationship with the Studentrequired
Parent/Guardian 2
First Name
Last Name
Relationship with the Student

Additional Emergency Contact

Name
First Name
Last Name

T-shirt Size

We can not guarantee, but we will make every effort to match your order.

Lunch Order

The lunch provider can make lunches appropriate for students with allergies to dairy products, eggs, nuts and mayonnaise. Service is NOT available for students with other food allergies, and we apologize for any inconvenience this may cause.
Do you wish to order a "bento lunch" for your child?required
Type of Lunchrequired

 

Food Allergiesrequired
AllergiesrequiredCAUTION: Lunches are prepared in a facility that is NOT free of the above ingredients.
CAUTION: Lunches are prepared in a facility that is NOT free of the above ingredients.

Parent Authorization & Consent

I verify that the information on these two pages is correct and the student described has permission to participate in all Nagoya International School (NIS) Summer Program activities. I understand that my child is under school supervision but neither NIS nor those in charge shall be held responsible in case of accident.  In the event of illness, injury or accident involving my child, I understand that I will be contacted at the phone numbers listed on this document.  I give permission for NIS staff, administration or designated authorities to provide routine care and over-the-counter medication for my child’s needs.  If I cannot be reached in the event of an emergency, I authorize NIS staff, administration or designated authorities to act on my behalf involving my child, and provide treatment as warranted.  I understand that this form may be photocopied and information may be shared with members of the NIS staff.

Photo Consent: During the NIS Summer Program, photographs of your child participating in the program may be taken by staff of NIS. These photographs will be used for NIS publications, websites and official NIS social media sites (i.e. Facebook, Twitter, Instagram etc.). Student names will not appear online or in any of these publications. We also encourage all parents to post these photos on their own social media sites as well. Parents are asked to be thoughtful when posting images of students on their own social media sites, but we cannot guarantee that student names will be left off those posts. Your authorization to use photos of your child in NIS publications, website and social media, and on other parents’ social media is required for enrollment into the NIS Summer Program.


私は、前述の内容に偽りがないこと、及び、前記の生徒が名古屋国際学園(NIS)のサマープログラムの活動に参加することを許可したことを証明します。私の子どもは学校の管理下にありますが、事故が起きた場合、NISも監督責任者も責任を負わないことを理解します。私の子どもが病気やケガ、事故にあった場合には、前記の電話番号に連絡を頂くものと理解します。私は、NISのスタッフ、責任者、または指定された機関が、必要に応じて私の子どもに所定の処置または市販薬を与えることを許可します。もし緊急の場合に私に連絡がつかない場合には、NISスタッフ、責任者、または指定された機関が、私に代わり必要な応急処置をすることを認めます。私は、この書類の複製及びここに記載された情報がNISの職員に共有されることを理解します。

写真の使用許可: サマープログラムの期間中、NISの職員がお子様の写真を撮ることがあります。これらの写真は、NISの広報物、ウェブサイトおよびNISのソーシャル・メディア(フェイスブック、ツイッター、インスタグラムなど)に掲載させて頂きます。お子様の名前が掲載されることはありません。また、NISは保護者の皆様がこれらの写真をご自身のソーシャル・メディアに投稿して頂くことを推奨させて頂いております。投稿にあたりましては、お名前の表記など十分にご配慮の上ご使用頂きますようお願い申し上げます。保護者の皆様によるこれらの写真のご使用にあたりましては、NISは責任を負いかねますのでご了承下さい。プログラムご参加にあたりましては、NISの上記媒体、および、他の保護者のソーシャル・メディアへのお子様のお写真の掲載をご了解頂くものといたします。
Parent Authorization and Consentrequired
Must contain a date in M/D/YYYY format
Please untick the box if you do NOT wish to receive information about NIS programs
How did you first learn about the NIS Summer Program?requiredPlease select up to 13 choices
Please select up to 13 choices
Have you seen or followed any of our social media below?requiredPlease select up to 6 choices
Please select up to 6 choices

Thank you for your application!

2022 Courses

Fun from Previous Years

Program Details

2022 Summer Session

  • August 1-5 9:00-15:00 

COVID-19 Risk Management Plan

English   Japanese   

Application Deadlines

  • July 1

Application Requirements

Students must be between Preschool 4 and Grade 5/6 (age 4-12) and have a basic understanding of English, sufficient enough to allow them to follow directions safely and participate in the activities with enjoyment. Please see the requirements under "Enrollment Eligibility".

Session Fees

¥35,000 per student, per session (Lunch fees separate)  *Payment includes the popular Summer Program T-shirts!

Contact

Email: summerprogram@nis.ac.jp    
Tel: 052-736-2025
 

 

2022 Packing List

  • Change of clothes (for younger students)
  • Closed shoes (for PE classes) - i.e. no sandals or crocs
  • Water bottle
  • Hat (for outside play)
  • Hand towel
  • Lead pencils
  • Colored pencils
  • Scissors
  • Glue (stick or equivalent)

 

NIS now has an official LINE@ account!


Friend us HERE to get the latest information!