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.
Biller’s details Title:
First name:
Relationship type:
Mother
Last name: Father
Other
(specify)
Home address: (include post code)
Home phone:
Mobile phone:
Business phone: Email:** Company name: Position: **Invoices and statements will be sent to the email address of the person/company responsible for the fees.
School bus service required?
Yes
No
Don’t know
Brothers & sisters ACG Student ID number
Name
Current year level or last year attended
(if at ACG School Jakarta)
Parent/guardian declaration I/We declare that the information provided in this enrolment application is true and correct. I/We agree to the use (including disclosure) of the above information by the staff of the School for any purpose related to the education or wellbeing of the student concerned (including use of email for communication purposes).
I/We hereby authorise ACG to release, or make available through electronic or other means, to the student and the parents and/or guardians of the student any information about the student which it creates, or receives in the course of the student's enrolment with ACG, including course results and personal information relating to the student's well being. I/We agree to participate in school field trips, camps, visiting performances and external examinations which are part of the learning programme and may incur an additional fee.
I/We agree to abide by the Contract of Enrolment and to ensure that the student complies with the school rules. I/We agree that the School may contact the student’s current/ previous school in order to obtain or verify information relating directly to this enrolment.
I/We agree that any images or videos taken of the student throughout the period of enrolment may be used by the School/College for promotional purposes.
I/We agree to guarantee the payment of tuition and course fees by the due date.
Parent/guardian’s name
Parent/guardian’s signature
ACG School Jakarta T: (+62 21) 2978 0200 | F: (+62 21) 781 4827 | E: acgjkt@acgedu.com Jl Warung Jati Barat (Taman Margasatwa) no 19, Jati Padang, Pasar Minggu, South Jakarta 12540 | jakarta.acgedu.com
Day
Month
Year
Contract of Enrolment Contract of Enrolment
English Language Support (ELS)
Payment of fees
Students requiring additional English Language Support will be placed in a programme where a per-semester ELS fee applies. The ELS status of the student will be reviewed each term. This ELS fee funds the considerable additional staffing and resources for this programme.
Enrolment is subject to the availability of places within the School. If the School reserves a place for a student and offers enrolment, then, subject to payment of the development fee, this Contract of Enrolment is binding as a contract on the School and the applicant/s. Tuition fees (by annual payment or 2 semester payment) are payable no later than three weeks prior to the commencement of class. Monthly payments are approved for special cases only. The School may cancel the enrolment of any student enrolled if tuition fees, course fees and other fees have not been paid by the dates specified.
Cancellation/Withdrawals
All notices of cancellation/withdrawal should be advised in writing to the Principal. Advice of cancellation/withdrawal should be given at the earliest possible time and in any case at least six school weeks before it is effective. Tuition fees and English Language Support (ELS) fees, where applicable, are payable until the end of the six school weeks’ notice period. In Term 4, notice of cancellation/withdrawal must be received at least six weeks prior to the end of term. Where no notice is given, a fee to the amount of 25% (twenty-five percent) of the annual tuition fees and any applicable ELS fees will be charged, payable to the School in lieu of notice.
Refunds
If written notice is received at least six school weeks prior to cancellation/withdrawal, a prorata refund on tuition fees and ELS fees (where applicable) is made according to school policy. Please note that the application fee, development fee and extra-curricular fees are non-refundable. The School will not refund the tuition fees of any student whose offer of place is withdrawn because of incorrect and/or fraudulent documentation, from a period beginning six school weeks prior to school commencement. The School will not refund the tuition fees of any student who is removed from the School roll through non-attendance or expulsion. The School may cancel the enrolment of any student who is absent for twenty-one school days (in any one year) with no satisfactory explanation.
An English proficiency test may be required for students wishing to attend ACG School Jakarta.
Infringement of rules
If a student does not comply with the School rules, as amended from time to time, the School reserves the right to suspend or expel the student. No refund of fees will be made.
Liability
To the fullest extent permitted by law or in equity, the School shall under no circumstances be liable to the student or the applicant/s or any other person, for direct or indirect, or consequential loss or damage of any kind, arising out of, or attributable to any breach by the School of its obligations under the Contract of Enrolment, negligence on the part of the School, or any act or thing done or not done by the School. For the purpose of this Contract of Enrolment, consequential loss shall include (without limitation), loss of income or profit and loss or damage to persons or property.
Obligation by the School
The School undertakes to provide tuition as set down from time to time in the prospectus. The School may decline to offer a subject if there are insufficient students wishing to study it, or there is no staff member available to teach the course. In such cases, every effort will be made to find a replacement teacher or to offer other courses. At times, it may also be necessary to close the roll in a subject if it is deemed to be full by the Principal.
Privacy
The information collected by the School during the enrolment process and during the period in which the student is enrolled at the School is intended for use in connection with the education and wellbeing of the student and may be used by any of the staff of the School or consultant to the School in connection with that purpose. Information may be retained to enable the School to contact former students. Students have the right of access to and correction of personal information collected by the School.
Enrolment Acceptance Form Please read carefully, complete all sections of this form and forward to the School.
Cancellation/Withdrawal • All notices of cancellation/withdrawal should be advised in writing to the Principal. • Advice of cancellation/withdrawal should be given at the earliest possible time and in any case at least six school weeks before it is effective. • Tuition fees and English Language Support (ELS) fees, (where applicable), are payable until the end of the six school weeks’ notice period. • In Term 4, notice of cancellation/withdrawal must be received at least six weeks prior to the end of term. • Where no notice is given, a fee to the amount of 25% (twenty-five percent) of the annual tuition fees and any applicable ELS fees will be charged, payable to the School in lieu of notice.
• If written notice is received at least one month prior to cancellation/withdrawal, a pro-rata refund of transport fees may be made. • Please note that the application fee, development fee and extra-curricular fees are non-refundable. • The School will not refund the tuition fees of any student whose offer of place is withdrawn because of incorrect and/or fraudulent documentation, from a period beginning six school weeks prior to school commencement. • The School will not refund the tuition fees of any student who is removed from the School roll through nonattendance or expulsion.
English Language Support (ELS) I/We understand that the student: (Please tick the appropriate box)
Refunds
Will require ELS
• If written notice is received at least six school weeks prior to cancellation/withdrawal, a pro-rata refund on tuition fees and ELS fees (where applicable) may be made according to school policy.
Will not require ELS
Declaration • I/We hereby accept the offer of place issued to the student. • I/We agree to guarantee the payment of tuition and other applicable fees by the due date including ELS fees where the School requires the student to take an ELS programme. • I/We agree to the School’s Cancellation/Withdrawal policy as stated above. This document supersedes any prior undertakings or terms and conditions between the School and the student/fee payer. I/We have read and understood the above conditions and agree to them.
Name of student
Student ID number
Parent/guardian’s name
Parent/guardian’s signature
Day
Month
Year
As at November 2017, every attempt was made to present accurate information in this enrolment acceptance form. ACG School Jakarta reserves the right to change without notice programmes, terms and conditions both before and after students’ admission. For the most up to date fees and course information, please refer to our website: jakarta.acgedu.com
ACG School Jakarta T: (+62 21) 2978 0200 | F: (+62 21) 781 4827 | E: acgjkt@acgedu.com Jl Warung Jati Barat (Taman Margasatwa) No 19, Jati Padang, Pasar Minggu, South Jakarta 12540, Indonesia | jakarta.acgedu.com