Bina Bangsa School

School Information Please fill the required fields * Campus * : Choose Campus Kebon Jeruk Pantai Indah Kapuk Bandung Semarang Malang Balikpapan Applying for Level * : Choose Level Prenursery Nursery Kinder 1 Kinder 2 Primary 1 Primary 2 Primary 3 Primary 4 Primary 5 Primary 6 Secondary 1 Secondary 2 Secondary 3 Junior College Bridging Junior College 1 Junior College 2 Academic Year * : 2022-2023 2021-2022 2020-2021 2019-2020 2018-2019 How did you know about Bina Bangsa School ? * : Outdoor Ads: Banners Publication: Magazine, Newspaper Online: Website, Google search Social Media: Facebook, Instagram BBS Family / Friend Non-SPH Family / Friend Message Blast: Email, WhatsApp Printed Materials: Poster, Flyer, Invitation Student Information Full Name (as shown in Birth Certificate) * : NIK (as shown in Family Card (KK) : Full Name (as shown in Passport) *: Gender * : Select Male Female Religion * :

Date of Birth * :

Place of Birth * :

Nationality * :

Home Address * :

Language (s) Spoken at home * :

Last School Attended Level * :

Last School Attended * :

Upload Photo * :

Sibling Information Name of Sibling(s) Gender Age Current School / University 1. Select Male Female 2. Select Male Female 3. Select Male Female 4. Select Male Female 5. Select Male Female Parents Information Father / Guardian Mother / Guardian Full Name * : Nationality * : Religion * : Home Addres * : Phone Number * : Mobile Number * : Educational * : Fax Number: Email Address * : Occupation * : Name of Company: Business Address: Phone Number (Office): Attachments Application must be accompanied by the following : Copy of Birth certificate : Copies of School Report Book from previous school :

Copy of Parents’ Marriage Certificate :

Copy of Parents’ ID card :

Copy of Student’s Passport :

Family Card :

Contact Information Communications preferences between school and parents/guardian * : Please Select SMS Text Message Email Phone Call In case of emergency, please contact * : Please Select Father Mother Guardian Caregiver Others Admission Rule & Regulations Account Name * : BCA Account Number * : By signing this form, I declare that : All the information given on this form is true and I shall accept responsibility if the information and documents supplied are not accurate or falsefied in any way. All Bina Bangsa School students must abide by the rules and regulations of the school. The school reserves the right to make changes to the rules and regulations when necessary. Registration fee is payable upon registration (for new students only). Registration fee is non-refundable whe the applicant chooses to reject the school's offer. However, it is refundable when the school decides not to accept the applicant. All documents required must be submitted with this registration. The last school may be submitted when it is available The school receipt for registration must be shown on the day of the admission test. Registration is considered complete when all items in the registration checklist are enclosed. All fees stated in the Letter of Offer must be paid by deadlines stated in order to retain a place in the school. Failure to do so may result in loss of placement and forfeiture of any fee(s) paid. All paid fees are neither refundable or transferable. If the security deposit is not taken within a period of 6 month upon the graduation / exitof my child, the the security deposit will be forfeited and be made non refundable by Bina Bangsa School. I understand and accept that my child must study Faith Builder and Character Fisrt I understand and accept that the school provides a holistic and Christian environment. I understand that the school is not equipped to provide additional facilities or suport for students with special needs. It is important therefore to provide full disclosure to school at the time of enrolment if your childhas special needs. I understand and agree to abide by the rules and policies stated above.  ( I Understand and accept Admission rules and Regulation * )