Please fill out and submit us the application form below.

• 日本語でご記入いただけます。

Parent's Information

Child's Information

Q1. Does your child have any allergy? If you answered “Yes”, please answer Q2.
---NoYes

Q2. What kind of allergic does he/she have?

Q3. If your child has the Food Allergy or hate food, please tell us the problem foods.
MilkEggsFishCrustacean ShellfishTree nutsPeanutsWheatSoybeansOther
* If you choose "Other", please tell us the problem foods.

Q4. If you have any request or information, please tell us. (Wearing a diaper or not/ The time of nap etc.)

Date and Time of Use

Please check the date that you want to leave your child and please be sure to fill out “Time of use” your actual time that you leave and collect your child.

List of things you need to bring

Please bring these items below because we cannot provide or lend any items for your child.

• In terms of hygiene, please just bring foods that can be kept at room temperature.
• Please write your child’s name on every belonging.

• If your child needs to take milk, please tell us the interval and the amount of milk per one time.
  about ml/1 time (Interval: hours)

Thank you for your information.