Apply | Japan Manga & Culture Summer Program

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Registration Form

Complete all sections to submit your application. Spaces are limited.

Day 6 activity choice*

Student Full Legal Name (as on passport)*

Preferred Name / Nickname

Date of Birth*

Age at Time of Travel*

Gender

Nationality / Citizenship*

Dietary restrictions or food allergies

Current School Name

Grade Level

Student Phone Number (optional)

Student Email (optional)

Allergies (food, medication, environmental)

Please list any allergies the student has. If none, write "None".

Medical Conditions

Please list any medical conditions the student has. If none, write "None".

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