Application Form Student information Proposed start date:
Proposed year level: (Kindergarten/Years 1–13)
First name(s):
Last name:
Middle name(s):
Preferred name:
Date of birth:
Gender:
Language: (list up to three)
Ethnicity: (list up to three)
Country of citizenship:
Country of birth:
Home phone:
Student’s mobile phone:
Home address:
NISN: (Indonesian students only)
Female
Male
Religion: Current school:
Current year level:
Family information Title:
Father/Guardian
First name: Last name:
Are you the main contact person for the student?*
Yes
No
Home address: (include post code)
Home phone:
Mobile phone:
Business phone: Email: Company name: Position:
Mother/Guardian Title:
First name: Last name:
Are you the main contact person for the student?*
Yes
No
Home address: (include post code)
Home phone:
Mobile phone:
Business phone: Email: Company name: Position:
Emergency contact In the case of emergencies and if parents live apart, please indicate which parent is to be contacted by the School. Mother
Father
Other
(specify)
Other special instructions:
*One parent/guardian must be registered as the main contact person for the student.