New User Form

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number of student to register *

Student 1

Student (1)

First Name *

Date of Birth (mm/dd/yyyy) *

Gender *

School Name *

School Name (other) *

Student 2

Student (2)

First Name *

Date of Birth (mm/dd/yyyy) *

Gender *

School Name *

School Name (other) *

Student 3

Student (3)

First Name *

Date of Birth (mm/dd/yyyy) *

Gender *

School Name *

School Name (other) *

Student 4

Student (4)

First Name *

Date of Birth (mm/dd/yyyy) *

Gender *

School Name *

School Name (other) *

More Info

Alternative phone number

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Alternative Contact Name

Permission to use photographs taken during class

Students attending classes in Coding Lab courses may be photographed. Photographs of students may be used in a variety of media to celebrate a student’s success in a particular area or for educational purposes or to promote activities at the school. Photographs of children may also be used in web site and other promotional material. These will not be accompanied by children’s names. We need parental permission to publish children’s photographs. No child’s photograph will knowingly be published without parent permission. The ownership of such material is retained by the school.

I do give permission for my child’s photograph to be used in the Coding Lab website and other media.
I do NOT give permission for my child’s photograph to be used in the Coding Lab website and other media.

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New User Form

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Shirokanedai Campus

Ebisu Office

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