Enrollment Application

Thank you for your interest in The Clubhouse.

Please complete the application form below as accurately as possible. After reviewing your application, a member of our team will contact you regarding the next steps in the enrollment process.

If you have any questions before applying, please don’t hesitate to contact us.

Step 1 of 2
Program Applying For

Student Information

Child's Name
Gender
Date of Birth
English Ability
Please tell us about any medical conditions, allergies, medications, developmental needs, learning differences, dietary restrictions, or other information that would help us support your child.
Home Address

School Information

Parent/Guardian Information

Parent/Guardian Name
Relationship to Child
Email Address

Agreement and Authorization | 同意・承諾書

Please read the following statements carefully. By checking each box, you confirm your agreement before submitting your application.

Agreement: Information provided is accurate
I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that providing false, misleading, or incomplete information may affect my child’s admission to or continued enrollment at The Clubhouse.
Agreement: Emergency medical authorization
I authorize The Clubhouse staff to take appropriate action in the event of an illness, injury, or other emergency involving my child. This may include contacting emergency services and arranging emergency medical treatment when necessary. I understand that The Clubhouse will make every reasonable effort to contact me or my designated emergency contacts as soon as it is safe and practical to do so.
Agreement: Use of child's image
I authorize The Clubhouse to photograph or record my child during school activities and to use those images or recordings for school-related purposes, including the website, social media, printed publications, and promotional materials. I understand that my child’s full name and other personal information will not be published in connection with these images without additional permission.
Desired Start Date
Leave blank if you have not yet decided.
Please enter the full name of the parent or legal guardian completing this application. A handwritten signature or personal seal (hanko), if applicable, will be requested during the enrollment process.
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