Select Branch :

    **please contact us for other branches

    A: PERSONAL DETAILS
    Student Family Name

    Student Given Name

    Sex
    MaleFemale

    Address

    Address 2


    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