Rev. 4/14 New Hope International School Mommy and Me Application Form Date _____ / _____ / _____ Parent’s Name ___________________________________________________________ Home Address _________________________________________________________________________ Telephone Mobile Phone ______________________ E-mail (PC): ______________________ ______________________________________________________________________ E-mail (Mobile): ___________________________________________________________________ Please check available days. (Tue) _____ (Wed) _____ (Fri) _____ Child's Name Age ___________________________ Birth date Sex M _______ F If your child has food allergies, please list them. ____________________________________________________________________________________ New Hope International School, 5-1-2 Narimasu, Itabashi-ku, Tokyo, 175-0094. Tel 03-5383-0421. www.newhopeclc.jp Email [email protected] 175-0094 5-1-2 Tel. 03-5383-0421. www.newhopeclc.jp [email protected]
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