BCH e-Academic 1.0

Father / Male Guardian

Full name

Place of Birth

Date of Birth

Nationality

Education

Religion

Occupation

Full Address

Mobile Phone

Home Phone

E-mail

MOTHER / FEMALE GUARDIAN

Full name

Place of Birth

Date of Birth

Nationality

Education

Religion

Occupation

Full Address

Mobile Phone

Home Phone

E-mail

Emergency (if we can't contact both we can contact this number )

In the event that Parents / Guardians cannot be contacted, please supply the name, relationship and phone number of other relations, or neighbours who could act for the Parents / Guardian in an emergency or who would be prepared to be collect the above listed child, if ill etc and take him / her home.

Name

Emergency Phone

Doctor

Doctor's Phone

Insurance

Ambulance No.

Has this child been immunized for his/her age ?

Visual Defects ?

Detail

Hearing Defects ?

Detail

Speech Defects ?

Detail

Details of Chronic Illness or Allergies

Are there any other conditions (i.e Special Needs) which the school should know about in the inrests of your child ?

Previous School Name

Previous School Status

Have you ever heard about Cambridge / Oxford AQA / Pearson Edexcel before?

From:

Previous School (Please indicate if Montessori)

Has this child been physiological tested ?

By Whom ?

When ?

Reason

1. Please indicate any previous kindergarten, preschool or school experiences you would like us to know about

2. Does your child have particular talents or special educational needs? (please give details)

3. What are the child's interests, occupation, hobbies, sports, best subjects, family activities?

4. What sorts of activities you like to do with your child ?

5. Does he/she have any particular like/dislike of aversions?

6. How would you describe your child's temperament?

7. Have you any particular concerns about your child?

8. Further observations or comments about your child.

9. What do you know about Montessori?

10. How did you hear of Montessori?

11. What in particular has brought you to this method of education?

12. What are your expectations of this system of education?

13. Have you any reservations about the Montessori philosophy?

14. Is there anything about your child you would like to highlight?

Birth Certificate

ID Card (KTP/PASSPORT/SIM)

Family Card (KK)

Kitas/Kitab

Past Education Sertificate

Past Education Transcript

All document accepted: *.gif *.jpg *.png max. file size 1MB

I understand that this application places the above-mentioned child REGISTRATION FEE for each and every child accompanies this this application and i accept that this fee will not be refundable, irrespective of whether a place is offered or not. This application does not constitute the offer of the place. Upon the offer of a place, an INITIATION FEE is required to confirm acceptance of the offer.

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Yayasan Griya Anak

CHILDREN'S HOUSE - CENDEKIA HARAPAN

STUDENT APPLICATION FORM All fields are required