Application Form – Thinkology

Student Information

Student First Name *

Student Last Name *

Student Japanese Name (if any)

Date of Birth *

Month

Day

Year

Gender

School Name *

Grade Level *

Home Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Relationship *

Parent 1 E-mail *

Parent 1 Mobile Phone *

Parent 2 First Name

Parent 2 Last Name

Parent 2 Relationship

Parent 2 E-mail

Parent 2 Mobile Phone

Emergency Contact Name *

Emergency Contact Phone *

Relationship to the Child *

Medical/Physical Restrictions (if any)

Can we have your permission to use a child's photos or videos for publicity, websites, and marketing purposes? *

Payment Option *

Terms and Service Agreement

Please read and agree to our terms of service.
THINNKOLOGY Terms of Service Agreement

I agree to the terms of service

Do you have any questions or comments?