Full Name
Click here to enter text. / Click here to enter text. /(Family name) / (Given name)
Place & Date of Birth / City & date / Present Age Year / number / Year / number /
Gender / ☐ / Male / ☐ / Female / (Please click to select)
Nationality / Click here to enter text. /
Language Spoken Home / Click here to enter text. /
Other Language Spoken / Click here to enter text. /
Current Residential Address / Click here to enter text. /
Click here to enter text. /
House Phone Number / Click here to enter text. /
Religion / Click here to enter text. /
(any religious beliefs, customs or traditions which teh school needs to be aware of)
FATHER / MOTHER
Full Name / Click here to enter text. / Click here to enter text. /
Nationality / Click here to enter text. / Click here to enter text. /
Profession / Click here to enter text. / Click here to enter text. /
Place of Employment / Click here to enter text. / Click here to enter text. /
Email Address / Click here to enter text. / Click here to enter text. /
Office Phone Number / Click here to enter text. / Click here to enter text. /
Mobile Phone Number / Click here to enter text. / Click here to enter text. /
Siblings / Name / Age / School
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Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Grade / Year Attended / Name of School / Branch City, Country
Level / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Level / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Level / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Language of instruction at previous school?
Please click on the box to select / ☐English / ☐Mandarin / ☐Bahasa Indonesia / ☐Other / If Other please specify for the Language here /a)Spoken English / ☐Fluent / ☐Fair / ☐Little / ☐None
b) Written English / ☐Fluent / ☐Fair / ☐Little / ☐None
If English is not the first language at home, how much formal instruction in English ahs your child had?
Has your child ever attended NationalHigh Jakarta School?
Please click / ☐No / ☐Yes / year attended: Click here to enter text. / At Level: Click here to enter text.
Has your child ever been diagnosed as having a learning-difficulty or had any special or remedial help in the past
Please click / ☐No / ☐Yes / Details:
Does your child have any behavioral traits or special needs of which the teacher be aware of?
Please click / ☐No / ☐Yes / Details:
Has your child ever shown special skill in sport games? Has he/she ever played for a school team?
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Does he/she have any particular hobby or musical ability?
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I certify that all statement in this REGISTRATION FORM is complete and true. I understand that any misinformation may result in denial of my application or dismissal from admission.
PARENT’S NAME / Click here to enter text. / DATE: / Click here to enter text. /