RUGBY SCHOOL JAPAN: NOTICE OF WITHDRAWAL FORM

Date

Attention: Mr Tony Darby, Principal, Rugby School Japan

Dear Mr Tony Darby

Please be informed that my child/children as listed below will be withdrawn from:

Rugby School JapanBoarding Houses only

Date of Withdrawal (last day in School)

Reason for leaving

Student(s)

Please enter your contact details below:

Forwarding address

Country

Telephone

Email

Next School:

PLEASE NOTE

Notice of intention to withdraw students from the School and or the Boarding Houses must be made in writing
and given to the Principal’s Office at least one academic term (excluding term breaks and school holidays) before the intended withdrawal date (herein called the “Mandatory Withdrawal Notice Period”). The Mandatory
Withdrawal Notice Period is calculated from the day after the written Notice of Withdrawal is received by the Admissions Office. This requirement is applicable irrespective of the time of withdrawal, including at the end of any academic year. A penalty fee is incurred if inadequate notice is given.

The school provides a leaving certificate for departing students. It takes approximately two working weeks to complete transfer documentation. Documentation will only be released when all outstanding fees have been
settled and all library books have been returned.

Signatures

By signing, I/We confirm the above information is accurate and acknowledge RSJ’s Mandatory Withdrawal Notice Period and conditions.
Please use your cursor or finger (if using a touchscreen) to sign in the box below

Mother’s signature

Father’s signature

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