Branch Muara KarangSenopati **please contact us for other branches A: PERSONAL DETAILS Student Family Name Student Given Name Sex MaleFemale Date of Birth Address Address 2 City (required) Postal Code Nationality Religion First language spoken .......................................................................................... B: FAMILY BACKGROUND Father's Name Identity No/KTP No Nationality Country of Birth Occupation Religion Contact Number Mother's Name Identity No/KTP No Nationality Country of Birth Occupation Religion Contact Number Your Correspondence E-mail .......................................................................................... C: HEALTH Is there any medical condition of which teachers should be aware? YesNo If yes, give details Is student on regular medication? If yes, give details. Name of Family Doctor Contact Number Contact Person in case of emergency (Other than parents) Name Relationship Contact Number .......................................................................................... School rules and regulations Read Here I have read and accept the school's rules and regulations.