Registration Form

Academic Information

Application to enroll school

Applying for grade

Start Date

Student Information

Full Name

Nick Name

Gender

Place of Birth

Date of Birth

Blood Group

Religion

Language at Home (Main Language)

Nationality

NIK/Passport No

Expiry Date

Former School

Choose a profile picture:

Family and Other Pertinent Information

Father

Nationality

Mother

Nationality

Home Address

City

Zip

Country

State

Phone

Mobile

Student Live with

Name of guardians(s) with whom student resides if other than parents

if parents are divorced (please attach a copy of any documents that indicate the legal custodial parents

If neither parent can be reached, whom can we contact in case of emergency?

Additional Information

Does your child have any allergies to food or medicine ?

Apakah anak Anda alergi terhadap makanan atau obat ?

if yes, please list the allergies below.

Jika Ya, tuliskan dibawah ini

Eating Problem ?

Ada masalah dengan makanan ?

What are your child's favourite activities ?

Permainan apa yang paling disukai anak anda ?

Is your child left handed ?

Apakah anak anda kidal ?

Does your child prefer to play alone ?

Apakah anak anda suka bermain sendiri ?

With Sibling ?

Dengan saudara kandung ?

With other children ?

Dengan anak yang lain ?

With parents ?

Dengan orang tua?

Does your child have any special fears ?

Apakah anak Anda memiliki rasa takut ?

Does your child have any speech problem ?

Apakah anak Anda memiliki masalah dalam berbicara ?

Does your child have any other problems that we should be aware of?

Apakah anak Anda memiliki masalah yang perlu kami perhatikan ?

Word child uses for urination?

Ucapan yang digunakan untuk buang air kecil ?

Word child uses for bowel movements?

Ucapan yang digunakan untuk buang air besar ?

Could your child dress him/herself?

Apakah anak anda dapat mengenakan baju sendiri ?

What time does your child usually eat ?

Jam berapa biasanya anak Anda makan ?

Breakfast ?

Sarapan ?

Lunch ?

Makan Siang ?

Dinner?

Makan Malam?

What method of behavior control is used at home?

Metode apakah yang Anda terapkan di rumah untuk mengontrol perilaku anak Anda?

Describe your child's personality?

Jelaskan mengenai kepribadian anak Anda ?

Attachment and Approval

Please attach Birth Certificate :

Please attach Kartu Keluarga :

Parent's ID Card:

We authorize the school to provide first aid, and if necessary, to take our children to the school designated hospital .

We Give permission to the school to take visual and/or audio recordings. School may use the recordings to produce programs for the purpose of education or published information.

We (undersigned, state that we have thoroughly read this application for admission form, understand the contents and agree to complete and attach all supporting documents required.