Nakayoshi Gakko Online Registration

Registration

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Please remember to include the name of your student(s) and if you are including a donation in the notes section of your Paypal transaction. All payments for must be RECEIVED by January 31 to secure your spot. We will continue to accept enrollments until May, however they will be given lesser priority if classes are full.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

TB Data for adult working in classroom

Person auth. to pick up+phone*

Person auth. to pick up+phone

Interest in add'l volunteering*

Interest in board-Y/N*

Contact #1

Contact #1 (Person Will Be Primary and Billing Contact by Default) First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 (optional - Might Not Receive All E-mail Communication) First Name

Last Name

Relationship

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade in Fall 2026*

Dentist and Phone #*

Special Needs - leave blank if none

Allergies (esp food) - leave blank if none*

Other pertinent medical information - leave blank if none

Primary Doctor and Phone #*

Fully Immunized against COVID-19-Y/N*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2025-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade in Fall 2026*

Dentist and Phone #*

Special Needs - leave blank if none

Allergies (esp food) - leave blank if none*

Other pertinent medical information - leave blank if none

Primary Doctor and Phone #*

Fully Immunized against COVID-19-Y/N*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2025-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade in Fall 2026*

Dentist and Phone #*

Special Needs - leave blank if none

Allergies (esp food) - leave blank if none*

Other pertinent medical information - leave blank if none

Primary Doctor and Phone #*

Fully Immunized against COVID-19-Y/N*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2025-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade in Fall 2026*

Dentist and Phone #*

Special Needs - leave blank if none

Allergies (esp food) - leave blank if none*

Other pertinent medical information - leave blank if none

Primary Doctor and Phone #*

Fully Immunized against COVID-19-Y/N*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2025-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade in Fall 2026*

Dentist and Phone #*

Special Needs - leave blank if none

Allergies (esp food) - leave blank if none*

Other pertinent medical information - leave blank if none

Primary Doctor and Phone #*

Fully Immunized against COVID-19-Y/N*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2025-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)