Student Registration Form
Please complete the form below with accurate information
Child Information (Informasi Anak)
Full Name (Nama Lengkap)*
Nickname (Nama Panggilan)
Date of Birth (Tanggal Lahir)*
Gender (Jenis Kelamin)*
-- Select --
Male (Laki-Laki)
Female (Perempuan)
Birth Order (Anak Ke)
Phone (No Handphone)
Address (Alamat)*
Medical History (Riwayat Medis)
Allergies (Alergi)
Previous Serious Illnesses (Penyakit berat yang pernah diderita)
Recurrent Illnesses (Penyakit yang sering diderita)
Parent Information (Informasi Orang Tua)
Mother
Name (Nama Ibu)*
Occupation (Pekerjaan Ibu)
Phone (No Handphone Ibu)
Social Media (Akun FB/IG)
Email (Email Ibu)
Father
Name (Nama Ayah)*
Occupation (Pekerjaan Ayah)
Phone (No Handphone Ayah)
Social Media (Akun FB/IG)
Email (Email Ayah)
Document Upload (Upload Berkas)
Upload Parent's ID (KTP)
Upload Family Card (KK)
Birth Certificate (Akta Kelahiran)
Payment (Pembayaran)
Payment Method (Metode Pembayaran)*
-- Select --
Bank Transfer
Cash
Payment Proof (Upload Bukti Pembayaran)
Submit Registration
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