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School Partners Abroad

Student Enrollment
Please attach your non-refundable enrollment fee of $100 to this form and return
to your teacher. Checks should be made out to Harry Preston/SPA.
NOTE: The additional fee for enrollments received after the deadline provided by your teacher is $75.
Your application cannot be processed without the correct fee.

Name of school _________________________________________________________________________

Name of teacher organizing program ___________________________________________________

Student Information
Name (Full legal name as it will appear on your passport):
* type or print legibly (form will be returned if illegible w/ late penalty applied)

__________________________________________________________________________________
Last

First

Date of Birth (mm/dd/yy) ______________

Middle

Sex ______ Country of citizenship : __________________

Address_____________________________________________________________________________________________
City __________________________________________________________ State _____________ Zip ____________
Parent/Guardian Name(s) ___________________________________________________________________________
Home telephone (

) ____________________________ Work telephone (

) ___________________________

email _____________________________________

Emergency Contact Information

Please provide the name of one person other than a parent/guardian that can be contacted in case of
emergency.
:
Name _____________________________________________________________________________
Home telephone:(

Work telephone: (

Relationship to student: _____________________________

:

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Student Enrollment Form

Permission for Emergency Treatment & Release
Student Full Name _____________________________________________________
On very rare occasions an emergency requiring hospitalization and/or surgery develops. Since minors may not,
as a rule, be administered an anesthetic or be operated on without the written consent of the parent or
guardian, we request that parents or guardians sign the following statement. Every effort will be made to
contact the parents or guardian before any major treatment. This form is to prevent a dangerous delay in case
an emergency does occur and we are unable to contact parents.
Please note, this form must be signed as is; no changes to the form will be accepted.
In the event of illness son/daughter/ward ___________________________________________________
(Full Name)
Born __________________________ we hereby authorize Japiu & School Partners Abroad their officers, and/or
(Date)

agents, to secure whatever medical treatment is deemed necessary, including the administration of an
anesthetic and surgery

____________________________________________________________
Parent(s) or Guardian Signature(s)
Date

__________________________________________
Parent(s) or Guardian Name(s) (Please print)

In conducting the School Partners Abroad program, Japiu and School Partners Abroad makes every effort to protect
the welfare and safety of the participants. However, neither Japiu, School Partners Abroad nor its employees, school
group leader(s), contractors or overseas cooperators are able to assume responsibility for damage to or loss of
property, personal illness or injury, or death while a participant is in the program. We require each participants
parent(s) or guardian to sign the following statement as an indication that this position is understood and accepted.

RELEASE
I hereby release Japiu, School Partners Abroad and their officers, employees, agents, school group leader(s)
and its overseas cooperators from any and all claims and causes of action for damage to or loss of property,
personal illness or injury, or death arising from any travel activity conducted by or under Japiu, School Partners
Abroad or its overseas cooperators.

____________________________________________________________
Parent(s) or Guardian Signature(s)
Date

__________________________________________
Parent(s) or Guardian Name(s) (Please print)

School Partners Abroad

2016 Payment Schedule

Checks should be made payable to : Harry Preston/School Partners Abroad

Due Date

Per Student

October 19

Student Enrollment Fee $100 ($175 after 10/19)

November 18

$300 deposit
(December 9 Airfare invoice sent)

**January 13

Airfare due
Non-refundable flight tickets will be purchased
shortly after January 13. (See Note)

March 7

Invoice Balance ($100 penalty after 3/20)

Note: Due to unforeseen surcharges imposed by the

airlines, School Partners Abroad may be forced to increase
the program fee to cover added flight costs.
Cancellation Penalties
1.

Student Enrollment Fee forfeited for any cancellation up to

January 13.

2.

January 13-March 7: $200 + Student Enrollment Fee + plane

ticket
Airplane
tickets once purchased are non-refundable.

3.

After March 7: $400 + plane ticket + any penalties assessed for

hotels, guides, transfers, reservations, JR rail pass, etc.

Airfare Invoice will be sent:

December 9

(for January 13 due date)

PVHS Japan Trip 2016

Deadlines:
1) You need to commit to the program by October 14, 2015. $100 nonrefundable application fee is due October 19, 2015 made payable to
Harry Preston, SPA.
2) You need to go online to USPS (Post Office) and get your passport by
December so we can purchase airline tickets as soon as possible.
Prices go up and we will buy tickets by January 13.

Cost: Approximate cost is $3500 plus money for meals and

souvenirs June 14-21. This cost could go up depending on
airfare and hotel increases. Please meet payment deadlines
promptly. Late payments result in penalties for the whole
group.
Tentative dates and schedule:
June 14
Depart San Francisco Airport
June 15
Arrive Kyoto (Kansai International Airport)
June 15-19
Stay in Ryokan Seiki (Japanese style inn)
visit famous sites of Kyoto
June 19-21
Visit Tokyo famous sites and stay in
Tokyo Central Youth Hostel
June 21-28
Homestay with students of Sakura High
School
June 29 Depart Narita Airport, Arrive San Francisco
Airport
For links and more information, go to
sramartinsensei.weebly.com and choose More and Japan
Trip or enter this URL:
http://sramartinsensei.weebly.com/japan-trip-2016.html