Summer Programme Registration Form
Student Information
Child's Name: *
Your answer
Gender: *
Date of Birth: *
MM
/
DD
/
YYYY
Age: *
Your answer
T-Shirt Size: *
Nationality: *
Your answer
First Language: *
Your answer
Current School: *
Your answer
Parent Information
Parent's Name: *
Your answer
Parent's Home Address: *
Your answer
Parent's Email: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
Handphone: *
Your answer
Emergency Contact: *
Your answer
Emergency Phone Contact: *
Your answer
Programme Selection
I would like to register for the following parts of the programme: *
10 days fee (payment in advance): BIS Student: IDR 1.800.000, Non BIS Student: IDR 2.200.000. Choose both weeks if you would like to have full programme.
Required
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