Family Name:
First Name:
Middle Name if applicable:
Date of birth:
Age (as of 29th June 2025):
Gender: MaleFemaleNon-Binary
Are you currently a pupil at Rugby School Japan or Phoenix House International School? YesNo
Are you joining the Full Residential Programme or Day Only Participation? Full ResidentialDay Only
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

BeginnerIntermediateAdvanced

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: MrMsMrs
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 RSJ Tennis Camp? 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 that all personal information submitted via this form is being handled by RSJ according to its Privacy Policy. Do you also agree to receive marketing communications from RSJ, and understand that you will be able to unsubscribe or change your preferences at any time. YesNo

This section is the parental consent and permission for excursion and sports activities in Japan for RSJ Tennis Camp 2025. 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 RSJ Tennis Camp 2025. 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.

This consent and permission form will remain in effect throughout the RSJ Tennis Camp 2025.

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 (e.g. antibiotics, Elastoplasts, Aspirin or any such medicines, any particular food etc)? YesNo

*If your answer is yes, please provide details.

3. Is the applicant actively sensitive to penicillin? YesNo

*If your answer is yes, please provide details.

4. If the applicant is asthmatic but able to administer their own inhaler, has the applicant received medical clearance to participate in the RSJ Tennis Camp 2025. YesNo

*If your answer is yes, please provide details.

5. Has the applicant ever had a heart condition, or suffered any pains in the chest when doing physical activity? YesNo

*If your answer is yes, please provide details.

6. Has the applicant any joint, bone or muscle problem that could worsen with exercise? YesNo

*If your answer is yes, please provide details.

7. Do you know of any medical or health reasons as to why the applicant should not take part in the camp or which might affect the applicant’s health and well being during the camp? YesNo

*If your answer is yes, please provide details.

8. Is the applicant receiving any medical treatment at present? YesNo

*If your answer is yes, please provide details.

9. Does the applicant have any special dietary requirements? YesNo

*If your answer is yes, please provide details.

10. Date of last anti-tetanus injection:

In the event of an emergency requiring immediate medical attention during the RSJ Tennis Camp 2025, RSJ will administer prompt first aid and seek necessary medical treatment. This includes assessing the participant’s health condition and performing required medical procedures. In emergencies, RSJ will promptly inform emergency contacts and provide necessary information. RSJ will not be liable for any costs incurred.

Noted

No participant is allowed to carry medication on their person or in their bag without prior declaration. For participants who have declared their medication, it must be clearly labeled with their name and usage instructions. The medication will be stored securely and dispensed as needed.

Do you have any medication that you need to bring? YesNo

*If your answer is yes, please provide details.

If participants claim any illness, our Health Center will administer the medication below if they judge they would work. Please indicate your permission for the following medication to be used by RSJ.

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