Nakayoshi Gakko Online Registration

Registration

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After sending in your payment, please submit the Registration Payment Form to assist the registrars in reconciliation : https://docs.google.com/forms/d/e/1FAIpQLSfl1wGUKBZQWXJooEtdjjJoFtxhlhF3UAyDxT2pJZtmdPRtaw/viewform A Code of Conduct Form is required to be submitted for each enrolled student : https://docs.google.com/forms/d/1OuoILNoVwIypPDoqoLYFMroiF-O7s7SKtfFJaif2jj8/viewform?ts=60078b92&edit_requested=true

* 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*

Home or 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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

Grade in Fall 2021*

Dentist and Phone #*

Special Needs

Allergies (esp food) - plz note n/a if none*

Other pertinent medical information

Primary Doctor and Phone #*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2020-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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

Grade in Fall 2021*

Dentist and Phone #*

Special Needs

Allergies (esp food) - plz note n/a if none*

Other pertinent medical information

Primary Doctor and Phone #*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2020-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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

Grade in Fall 2021*

Dentist and Phone #*

Special Needs

Allergies (esp food) - plz note n/a if none*

Other pertinent medical information

Primary Doctor and Phone #*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2020-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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

Grade in Fall 2021*

Dentist and Phone #*

Special Needs

Allergies (esp food) - plz note n/a if none*

Other pertinent medical information

Primary Doctor and Phone #*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2020-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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

Grade in Fall 2021*

Dentist and Phone #*

Special Needs

Allergies (esp food) - plz note n/a if none*

Other pertinent medical information

Primary Doctor and Phone #*

Date of most recent TB test/result*

Parent Board Mem-Curr/Past/Nev*

Child of NG Teacher-Y/N*

Ret stu/sib in 2020-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Enroll in Classes

Select Class

Add Another Student