Registration Form

Applicant Information
Last Name: __________________________________________
First Name: __________________________________________
Address: ____________________________________________________________________________________
Phone: __________________________________________
E-Mail: __________________________________________

 

 Emergency Contact
Last Name: __________________________________________
First Name: __________________________________________
Address: ____________________________________________________________________________________
Phone: __________________________________________
Relationship: __________________________________________

Please indicate number of students to be enrolled.

Please indicate the grade if an applicant is a high school student.

 Elementary Japanese – Level 1    ____ Fall [ 101 ]   ____ Winter [ 102 ]   ____ Spring [ 103 ]
 Elementary Japanese – Level 2    ____ Fall [ 201 ]   ____ Winter [ 202 ]   ____ Spring [ 203 ]
 Intermediate Japanese – Level 3    ____ Fall [ 301 ]   ____ Winter [ 302 ]   ____ Spring [ 303 ]
 Advanced Japanese – Level 4    ____ Fall [ 401 ]   ____ Winter [ 402 ]   ____ Spring [ 403 ]
Both the registration form and the tuition payment must be received by 5PM
three calendar days (Received by date) prior to the semester beginning.
JLSP accepts checks only; we do not accept cash or Credit / Debit cards.
Please check the appropriate items below.
____ Registration Form
____ Tuition Payment  ( Check No._______________  Total $_______________ )
I have read and understand the Tuition Refund Policy of the Japanese Language School of Philadelphia.
Signature: __________________________________________________
Mailing Address of JLSP Office
The Japanese Language School of Philadelphia
1445 City Line Avenue
Wynnewood, PA 19096
Phone: Tue.-Fri.
Sat.
Email: staff@jlsp.us

Registration Form