STUDENT NO : Attach photo here 3x4 cm CAMPUS Kebun Jeruk, Pantai Indah Kapuk, Jakarta

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, APPLICATIONApplication FORfor AdmissionADMISSION DATE: FATHER’S SIGNATURE

mychild,thenthesecuritydepositwillbe 10. Ifthesecuritydepositisnottaken withinaperiodof 6monthsuponthe graduation/exitof 9. There willbenorefund onanyof thefee(s)paid. already paid. placeintheschool.Failure to dosomayresult inlossof of placementandforfeiture anyfee(s) 8. Allfee(s)stated intheLetter of Offermustbepaid bythedeadlinesstated inorder to retain a 7. Registration isconsidered complete whenallitems intheregistration checklistare enclosed. 6. Theschoolreceipt forregistration mustbeshownonthedayof theadmissiontest. maybesubmitted whenitisavailable. 5. Alldocumentsrequired mustbesubmitted withthisregistration form. Thelastschoolreport whentheschooldecidesnotto accepttheapplicant. refundable shouldtheapplicantdecidesto reject theschool’s offer. However, itisrefundable 4. Registration feeispayable uponregistration (fornewstudentsonly).Registration feeisnon- therightto make3. Theschoolreserves changesto therulesandregulations whennecessary. 2. AllBinaBangsaSchoolstudentsmustabidebytherulesandregulations of theschool. information anddocumentssuppliedare inaccurate orfalsifiedinanyway. 1. Alltheinformation given onthisform istrueandIshallacceptfullresponsibility ifthe BY SIGNING THIS FORM, IUNDERSTAND THAT 14. I understand andagree14. Iunderstand to abidebythe rulesandregulations of theschool. thetimeof enrolment ifmychildhasspecialneeds. therefore studentswithspecialneeds.Itisimportant to provide fulldisclosure to theschoolat for thattheschoolisnotequippedto13. Iunderstand provide additionalfacilitiesorsupport andacceptthattheschoolprovides12. Iunderstand aholisticandChristianenvironment. andacceptthatmychildmuststudy 11. Iunderstand BangsaSchool.

Picpl Date Principal Approved by: Enrolling Officer :(Name) (Signature) Chinese (level) ( ) Placement test result : English MathOthers testAdmission results: Admitted (Level of Study )NotAdmitted Waiting List Date application received FOR OFFICIALUSEONLY SECTION D:DECLARATION ANDAGREEMENT MOTHER’S SIGNATURE forfeited andbe forfeited Faith or Builders made non-refundable . Character First b ia byBina