Application Form

STUDENT NO : Attach photo here 3x4 cm CAMPUS Kebun Jeruk,Jakarta Pantai Indah Kapuk, Jakarta Bandung Malang Semarang Balikpapan Applying for Level : Pre-Nursery Pr.1 Pr.5 Sec.3 Nursery Pr.2 Pr.6 JCB K1 Pr.3 Sec.1 JC 1 K2 Pr.4 Sec.2 JC 2 Academic Year : SECTION A : ATTACHMENTS Application must be accompanied by the following : Copy of Birth certificate Copies of School Report Book from previous school Copy of Parents’ Marriage Certificate APPLICATION FOR ADMISSION FOR APPLICATION Copy of Parents’ ID card Copy of Family Card Copy of Student’s Passport Registration fee Immunisation Record (for Pre-school only) Other documents to be submitted prior to commencement at BBS: • Student Health Form • A completed Student Contract SECTION B : STUDENT’S DATA Given name (s) : Family name/ Surname : Chinese name (if any) : Gender : Male Female Religion : Date of birth : D AY MONTH YEAR Place of birth : Nationality : Passport No : Home address : Phone number : Email address : Language(s) spoken at home : Last School attended level : Intended year of entry : NAME OF SIBLING(S) GENDER AGE CURRENT SCHOOL/UNIVERSITY LEVEL APPLICATION FOR ADMISSION FOR APPLICATION 1 2 3 4 5 SECTION C : PARENT’S DATA FATHER/GUARDIAN MOTHER/GUARDIAN Given name (s) Family name Nationality Religion Home Address Phone number (Home) Mobile number Fax Email address Occupation Name of Company Business Address Phone number (Office) Communications preferences between school and parents/guardian : SMS Text Message Email Phone Call APPLICATION FOR ADMISSION FOR APPLICATION In case of emergency, please contact : Father Mother Guardian Caregiver Others, SECTION D : DECLARATION AND AGREEMENT BY SIGNING THIS FORM, I UNDERSTAND THAT 1. All the information given on this form is true and I shall accept full responsibility if the information and documents supplied are inaccurate or falsified in any way. 2. All Bina Bangsa School students must abide by the rules and regulations of the school. 3. The school reserves the right to make changes to the rules and regulations when necessary. 4. Registration fee is payable upon registration (for new students only). Registration fee is non- refundable should the applicant decides to reject the school’s offer. However, it is refundable when the school decides not to accept the applicant. 5. All documents required must be submitted with this registration form. The last school report may be submitted when it is available. 6. The school receipt for registration must be shown on the day of the admission test. 7. Registration is considered complete when all items in the registration checklist are enclosed. 8. All fee(s) stated in the Letter of Offer must be paid by the deadlines stated in order to retain a place in the school. Failure to do so may result in loss of placement and forfeiture of any fee(s) already paid. 9. There will be no refund on any of the fee(s) paid. 10. If the security deposit is not taken within a period of 6 months upon the graduation / exit of my child, then the security deposit will be forfeited and be made non-refundable by Bina Bangsa School. 11. I understand and accept that my child must study Faith Builders or Character First. 12. I understand and accept that the school provides a holistic and Christian environment. 13. I understand that the school is not equipped to provide additional facilities or support for students with special needs. It is important therefore to provide full disclosure to the school at the time of enrolment if my child has special needs. 14. I understand and agree to abide by the rules and regulations of the school. FATHER’S SIGNATURE MOTHER’S SIGNATURE DATE: FOR OFFICIAL USE ONLY Date application received Application for Admission Admitted (Level of Study ) Not Admitted Waiting List APPLICATION FOR ADMISSION FOR APPLICATION Admission test results: English Math Others Placement test result : Chinese (level) ( ) Enrolling Officer : (Name) (Signature) Approved by : Principal Date .

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