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/1FAIpQLSdeXfaBousVQ-Gl2Dz2ivGRCFt3v9Hx5Vb8MFqwnIUV3IGAyg/viewform?usp=sf_link

* 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

Grade in Fall 2020*

Dentist and Phone #*

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*

Return. stu or sib in 2019-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Please also email your students' shirt sizes to registrar@nakayoshigakko.org since this form does not collect them.

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

Grade in Fall 2020*

Dentist and Phone #*

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*

Return. stu or sib in 2019-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Please also email your students' shirt sizes to registrar@nakayoshigakko.org since this form does not collect them.

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

Grade in Fall 2020*

Dentist and Phone #*

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*

Return. stu or sib in 2019-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Please also email your students' shirt sizes to registrar@nakayoshigakko.org since this form does not collect them.

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

Grade in Fall 2020*

Dentist and Phone #*

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*

Return. stu or sib in 2019-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Please also email your students' shirt sizes to registrar@nakayoshigakko.org since this form does not collect them.

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

Grade in Fall 2020*

Dentist and Phone #*

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*

Return. stu or sib in 2019-Y/N*

Child of MVBT Member-Y/N*

MVBT Dharma School-Y/N*

Please also email your students' shirt sizes to registrar@nakayoshigakko.org since this form does not collect them.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Enrollment Priority

I have read and understand that enrollment priority is given in the following order if the on-line application is completed and the payment received on or before February 21, 2020.

1. Children of Current Board Members
2. Children of NG Teachers
3. Children of Past Board Members
4. Returning students from the 2019 session
5. Siblings of returning students from the 2019 session
6. Mountain View Buddhist Temple members' children
7. Mountain View Buddhist Temple Dharma School students
8. New students who do not qualify for the priorities above (Lottery).

I've read the above and agree.

Payment Policies

Tuition: $460 per student for two week session. The actual cost of the program would be $760 per student if we had to rent comparable facilities.

Please send a $460 tuition payment to Nakayoshi Gakko to complete the registration process. If the class is full, your tuition will be refunded to you (if paid via Paypal) or your check will be shredded (if paid via check).

Cancellations: Cancellations made and confirmed by the Registrar(s) on or before April 15, 2019 will receive a $410 refund ($460 - $50 processing fee). Cancellations made after April 15, 2019 are not refundable.

Extended Care Fees (if applicable): Fees are $15 per day per child for accounts paid in full by April 16, 2019. After April 16, 2019 fees increase to $20 per day, per child, subject to availability. Emergency or unscheduled use of extended care is subject to availability and will be billed at $20 per day. Unused extended care is not refundable.

Extended Care Late Fee: The facility closes promptly at 5:30 PM. There is a five-minute grace period. Starting at 5:35 PM a late charge of $5.00 per minute is assessed.

I've read the above and agree.

Photography Release

As parent/guardian of the below named child or children (hereinafter "Child"), I acknowledge that audio recordings may be made and/or photographs may be taken of my Child or me during participation in demonstrations, field trips, games, contests, and classes and other activities set forth in the Nakayoshi Gakko descriptive materials ("Activities") offered during the Nakayoshi Gakko Summer 2020 session ("Summer Session"). "Photographs" shall mean a picture or likeness obtained by photographic reproduction, still or moving, using either traditional film media or digital recording or storage media, and further including any video tape or live television transmission. Photographs may be taken of me or my Child's person either alone or with other persons in any setting.

I provide authorization and consent to Nakayoshi Gakko its Board, officers, agents, volunteers, employees, successors and assigns (hereinafter "Recipient") to reproduce, perform, publish, create derivatives, and distribute (by whatever means including but not limited to, using newspapers or discrete media such as CD and DVDs, through the internet, through any other electronic medium presently in existence or invented in the future), of me and/or my Child's voice, Photograph or likeness (hereinafter collectively the "Property"), for any purposes, including but not limited to promoting, advertising, describing the mission, class offerings, demonstrations, or other programs and activities of Nakayoshi Gakko.

I do hereby release and forever discharge Recipient from any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages arising from Recipient's reproduction, performance, publication, creation of derivatives, and distribution of the Property.

I further hereby agree not to bring or consent to others bringing claim or action against Recipient on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on me, violates any other right whatsoever, including, without limitation, rights of privacy and publicity.

The Recipient is not obligated to use the Property in any manner, and shall have the right to assign its rights hereunder, without further consent, in whole or in part, to any person, firm or corporation.

I've read the above and agree.

Parental Consent, Release and Waiver

As parent/guardian of the below named minor child or children (hereinafter "Child"), I understand that my Child may participate in, attend or observe, or be transported to demonstrations, field trips, games, contests, and classes and other activities set forth in the Nakayoshi Gakko descriptive materials ("Activities") offered during the Nakayoshi Gakko Summer 2020 session ("Summer Session"). In consideration of the benefits to be derived and after carefully considering the risk involved, and further acknowledging that attendance in the Summer Session is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of the Child, I give permission for him or her to participate and/or engage in the Activities.

I HEREBY RELEASE AND WAIVE THE MOUNTAIN VIEW BUDDHIST TEMPLE AND NAKAYOSHI GAKKO AND THEIR ASSOCIATED BOARDS, OFFICERS, VOLUNTEERS, AGENTS AND EMPLOYEES (COLLECTIVELY "RELEASED PARTIES") FROM ANY AND ALL CLAIMS OR LIABILITY FOR ANY DAMAGES ARISING FROM PARTICIPATION IN ACTIVITIES, OR FOR ENTRY TO AND USE OF ANY FACILITIES AND EQUIPMENT AS PART OF THE SUMMER SESSION EVEN THOUGH THAT LIABILITY MAY ARISE OUT OF NEGLIGENCE, OR CARELESSNESS ON THE PART OF THE RELEASED PARTIES.

This waiver and assumption of risk shall be binding on me and the Child, and our respective heirs, personal representatives, relatives, spouses and assigns, and shall extend to the benefit of Released Parties. This waiver and release is intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I have fully read this waiver and release and fully understand its content and significance. Furthermore, the significance of this waiver and release of liability has been EXPLAINED TO THE MINOR CHILD.

I've read the above and agree.

Medical Emergencies

To the best of my knowledge, the below-named Child does not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent him or her from participating in the above mentioned activity, and, if required, he or she will obtain a medical examination and clearance. In case of emergency, I understand that every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge of the Activities to secure proper treatment, including hospitalizations, anesthesia, surgery, or injections of medications for my child.

I've read the above and agree.

Volunteer Commitment

I understand that I am responsible for fulfilling the volunteer commitments of :
1. Classroom work,
2. Committee support,
3. Pre or Post-session maintenance, and
4. MVBT Obon and Bazaar support.

If I am unable to personally fulfill the volunteer commitment, I will ensure that I will find another individual to fulfill the commitment for me and notify the Registrar of this change.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments