Family Name:
First Name:
Middle Name if applicable:
Date of birth:
Age (as of 1st September 2025):
Gender: MaleFemaleNon-Binary
Are you currently a pupil at Rugby School Japan or Phoenix House International School? YesNo
Copy of applicant passport (Bio Page):
Please upload the most recent applicant photo:

Address Line 1:
Address Line 2:
City:
Prefecture / District:
Country:
Postcode:

First Nationality:
Passport Number:
Second Nationality if applicable:
Passport Number:
Third Nationality if applicable:
Passport Number:

First Language:
Second Language if applicable:
Third Language if applicable:
English Proficiency: NativeFluentModerateLow

Current School:
Curriculum: I/GCSEA-LevelIBOthers
Language of Instruction:

Title: MrMsMrs
Family Name:
First Name:
Middle Name if applicable:
Gender: MaleFemaleNon-Binary
Email address:
Mobile Number:

Title: MrMsMrs
Family Name:
First Name:
Middle Name if applicable:
Gender: MaleFemaleNon-Binary
Email address:
Mobile Number:

Please provide the contact details of an English-speaking friend or family member if parents do not speak English.

Title:
Family Name:
First Name:
Middle Name if applicable:
Gender: MaleFemaleNon-Binary
Relationship to Applicant:
Contact Number:

Do you need to apply for a visa before entering Japan? YesNo
*If your answer is yes, Rugby School Japan will issue a letter of invitation for the applicant to submit to the Japanese Embassy or Consulate in the applicant's country of residence before travelling to Japan.

I give permission for my photographs to be used for social media: YesNo
*When Rugby School Japan publishes photos on social media for marketing purposes, we will not include any personal names.

1. Has the applicant ever been seen by an educational psychologist, occupational or speech therapist, psychiatrist or other specialist? YesNo
*If your answer is yes, please provide details:

2. Has the applicant ever received special help or attended classes for any learning, social, emotional or behavioural difficulties? YesNo
*If your answer is yes, please provide details:

3. Does the applicant have a medical or physical condition that may affect the activities during the 2025 Blues Global Rugby Academy? Is the applicant on any medication? YesNo
*If your answer is yes, please provide details:

4. Does the applicant have any food allergies or other dietary requirements? YesNo
*If your answer is yes, please provide details:

5. Do you agree to RSJ's Privacy Policy and to receive marketing communications? YesNo

This section is the parental consent and permission for excursion and sports activities in Japan for 2025 Blues Global Rugby Academy. We ask your consent after having understood and agreed to its contents. This consent will apply to all trips and sporting fixtures during the time the participant joins 2025 Blues Global Rugby Academy. All safety precautions and risk assessments are taken for the excursion and sports activities.

In order to ensure that the excursion and sports activities are positive and worthwhile experience for the applicant.

1. I undertake as follows:

The applicant will abide by all school rules and obey RSJ staff’s instructions at all times. I will inform RSJ immediately of any change in the particulars or in the event that I wish to revoke my consent to the excursions and sports activities.

2. I acknowledge that:
Any breach of the school rules or non-compliance with RSJ staff’s instructions may result in the applicant being excluded from one or more of the activities in the excursion and sports activities;
If the applicant is sent home as a result of section 2 above, I shall be responsible for the expenses of the applicant’s travel as well as for those of the accompanying RSJ staff;
While every effort has and will be taken to ensure the secure environment and safety of the applicant during the excursion and sports activities, I am aware of the inherent risks involved in the activities and/or excursions, and
therefore waive and release RSJ, its employees, directors, shareholders, affiliates, volunteers and officials from all claims for any injuries and damages, and any actions or demand of whatsoever nature, to the fullest extent
permitted by law; and

In case the applicant suffers injury or illness during the excursion and sports activities, emergency medical care will be sought and I will be notified.

Excursions will be at various venues in Japan.

This consent and permission form will remain in effect throughout the 2025 Blues Global Rugby Academy.

Noted

1. Does the applicant suffer from allergies, diabetes, migraine, epilepsy, or any other illness or disability? YesNo
*If your answer is yes, please provide details:

2. Is the applicant allergic to anything? YesNo
*If your answer is yes, please provide details:

3. Is the applicant sensitive to penicillin? YesNo

4. Is the applicant asthmatic and able to administer their own inhaler? YesNo

5. Has the applicant ever had a heart condition? YesNo

6. Does the applicant have any joint, bone, or muscle problems? YesNo

7. Are there any medical reasons affecting participation in the camp? YesNo

8. Is the applicant receiving any medical treatment? YesNo

Do you have any medication to bring? YesNo
*If your answer is yes, please provide details:

Can RSJ administer the following medications if needed?
Acetaminophen YesNo
Ibuprofen YesNo
Bifidobacterium YesNo
Throat Lozenges YesNo
Epipen YesNo
Creams for bruising/skin complaints/burns YesNo

Participants are responsible for their own medical insurance. No responsibility will be undertaken for any medical expenses as a result of inadequate insurance being in place.
Noted