2020 Application for:

Student Information

Grade placement for NIS students is based on the grades for the 2020-21 School Year.​​
Grade placement is based on year/month of birth, but in cases where students come from different international school calendar or cut-off date, considerations will be made for different placement​.​​​​​​​​

School History

5=Fluent 3=Communicate with effort 1=Limited​​​
(Please pick all that apply)​

Student Health History

(i.e. difficulty seeing, crossed/reddened/watery eyes, uses eyeglasses/contacts/hearing aid, etc.)​​
(eating/sleeping habits, bowel or bladder, teeth, skin, menstruation, weight, etc.)​​

If your family is covered by the Japanese Health Insurance plan, please send the copy of the plan to summerprogram@nis.ac.jp.


Family Information

T-shirt Size

(We cannot guarantee, but we will make every effort to match your order)​​

Lunch Order

The lunch provider can make lunches appropriate for students with allergies to dairy products, eggs,nuts and mayonnaise. Seivice is NOT available for students with other allergies, and we apologize for any inconvenience this may cause.

CAUTION: Lunches are prepared in a facility that is NOT free of the above ingredients.

Parent Authorization & Consent

I verify that the information on these two pages is correct and the student described has permission to participate in all Nagoya International School (NIS) Summer Program activities. I understand that my child is under school supervision but neither NIS nor those in charge shall be held responsible in case of accident.  In the event of illness, injury or accident involving my child, I understand that I will be contacted at the phone numbers listed on this document.  I give permission for NIS staff, administration or designated authorities to provide routine care and over-the-counter medication for my child’s needs.  If I cannot be reached in the event of an emergency, I authorize NIS staff, administration or designated authorities to act on my behalf involving my child, and provide treatment as warranted.  I understand that this form may be photocopied and information may be shared with members of the NIS staff.

Photo Consent: During the NIS Summer Program, photographs of your child participating in the program may be taken by staff of NIS. These photographs will be used for NIS publications, websites and official NIS social media sites (i.e. Facebook, Twitter, Instagram etc.). Student names will not appear online or in any of these publications. We also encourage all parents to post these photos on their own social media sites as well. Parents are asked to be thoughtful when posting images of students on their own social media sites, but we cannot guarantee that student names will be left off those posts. Your authorization to use photos of your child in NIS publications, website and social media, and on other parents’ social media is required for enrollment into the NIS Summer Program.


写真の使用許可: サマープログラムの期間中、NISの職員がお子様の写真を撮ることがあります。これらの写真は、NISの広報物、ウェブサイトおよびNISのソーシャル・メディア(フェイスブック、ツイッター、インスタグラムなど)に掲載させて頂きます。お子様の名前が掲載されることはありません。また、NISは保護者の皆様がこれらの写真をご自身のソーシャル・メディアに投稿して頂くことを推奨させて頂いております。投稿にあたりましては、お名前の表記など十分にご配慮の上ご使用頂きますようお願い申し上げます。保護者の皆様によるこれらの写真のご使用にあたりましては、NISは責任を負いかねますのでご了承下さい。プログラムご参加にあたりましては、NISの上記媒体、および、他の保護者のソーシャル・メディアへのお子様のお写真の掲載をご了解頂きますことをご理解下さい。

Thank you for your application!

Please provide an email address where we can send a link to your current form.

Email Address :