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Student Information - Informasi Siswa
Student's Name
*
First
Last
Nama Siswa Depan dan Belakang (Keluarga)
Layout
Student DOB
*
Student Country of Birth
*
Negara Lahir Siswa
Indonesia
Argentina
Australia
Austria
Belgium
Brazil
Canada
Chile
China
Colombia
Czech Republic
Denmark
Egypt
France
Germany
Greece
Hungary
India
Ireland
Israel
Italy
Japan
Kenya
Malaysia
Mexico
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Peru
Philippines
Poland
Portugal
Russia
Saudi Arabia
Singapore
South Africa
South Korea
Spain
Sweden
Switzerland
Thailand
Turkey
United Arab Emirates
United Kingdom
United States
Venezuela
Vietnam
OTHER
Student Address
*
State
Country
*
Negara
Indonesia
Argentina
Australia
Austria
Belgium
Brazil
Canada
Chile
China
Colombia
Czech Republic
Denmark
Egypt
France
Germany
Greece
Hungary
India
Ireland
Israel
Italy
Japan
Kenya
Malaysia
Mexico
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Peru
Philippines
Poland
Portugal
Russia
Saudi Arabia
Singapore
South Africa
South Korea
Spain
Sweden
Switzerland
Thailand
Turkey
United Arab Emirates
United Kingdom
United States
Venezuela
Vietnam
OTHER
Student's Email
Student Gender
*
Jenis Kelamin Siswa
Male - LakiLaki
Female - Perempuan
Student's Citizenship
*
Kebangsaan Utama
Indonesian WNI
Dual Citizen
Argentine
Australian
Austrian
Belgian
Brazilian
Canadian
Chilean
Chinese
Colombian
Czech
Danish
Egyptian
French
German
Greek
Hungarian
Indian
Irish
Israeli
Italian
Japanese
Kenyan
Malaysian
Mexican
Dutch (Netherlands)
New Zealander
Nigerian
Norwegian
Pakistani
Peruvian
Filipino
Polish
Portuguese
Russian
Saudi Arabian
Singaporean
South African
South Korean
Spanish
Swedish
Swiss
Thai
Turkish
Emirati (United Arab Emirates)
British (United Kingdom)
American (United States)
Venezuelan
Vietnamese
Other
City
*
Post Code
Students Mobile Phone
Student's WhatsApp Number (if not same as mobile)
Layout
Current Grade
*
Kelas Tahun Akademik Ini
Not Yet School - Belum Sekolah
Kindergarten - Playgroup
Preschool A
Preschool B
Grade Kelas 1
Grade Kelas 2
Grade Kelas 3
Grade Kelas 4
Grade Kelas 5
Grade Kelas 6
Grade Kelas 7
Grade Kelas 8
Grade Kelas 9
Grade Kelas 10
Grade Kelas 11
Grade Kelas 12
Religion
*
Agama
Islam
Christian
Catholic
Hindu
Buddha
Confucianism
Student Photo 3x4cm
Click or drag a file to this area to upload.
Pas Foto 3x4cm
Passport (Foreigners) WNA
Click or drag a file to this area to upload.
Passpor khursus WNA
Apply For Grade
*
Mendaftar Untuk Kelas
Kindergarten - Playgroup
Preschool A
Preschool B
Grade Kelas 1
Grade Kelas 2
Grade Kelas 3
Grade Kelas 4
Grade Kelas 5
Grade Kelas 6
Grade Kelas 7
Grade Kelas 8
Grade Kelas 9
Grade Kelas 10
Grade Kelas 11
Grade Kelas 12
Planned Starting Date
*
Akta Lahir (WNI)
Click or drag a file to this area to upload.
Birth Certificate (Indonesian Nationals)
KITAS/KITAP-Visa (WNA)
Click or drag a file to this area to upload.
khursus WNA
Fathers Information - Informasi Ayah
Father's Name - Nama Ayah
*
First
Last
Layout
Father Address if Different
Father's Occuation
Company Name (Father)
Father's Email
*
City
Father's Office Phone
Father's Citizenship
*
Kebangsaan Utama Ayah
Indonesian WNI
Dual Citizen
Argentine
Australian
Austrian
Belgian
Brazilian
Canadian
Chilean
Chinese
Colombian
Czech
Danish
Egyptian
French
German
Greek
Hungarian
Indian
Irish
Israeli
Italian
Japanese
Kenyan
Malaysian
Mexican
Dutch (Netherlands)
New Zealander
Nigerian
Norwegian
Pakistani
Peruvian
Filipino
Polish
Portuguese
Russian
Saudi Arabian
Singaporean
South African
South Korean
Spanish
Swedish
Swiss
Thai
Turkish
Emirati (United Arab Emirates)
British (United Kingdom)
American (United States)
Venezuelan
Vietnamese
Other
Father's Mobile Phone
*
Fathers WhatsApp Number
Mother's Information - Informasi Ibu
Mother's Name - Nama Ibu
*
First
Last
Layout
Mothers Address (If Different to Student)
Mother's Occupation
Company Name (Mother)
Mother's Email
*
Mother's City (If differerent)
Mother's Office Phone
Mother's Citizenship
*
Kebangsaan Utama Ibu
Indonesian WNI
Dual Citizen
Argentine
Australian
Austrian
Belgian
Brazilian
Canadian
Chilean
Chinese
Colombian
Czech
Danish
Egyptian
French
German
Greek
Hungarian
Indian
Irish
Israeli
Italian
Japanese
Kenyan
Malaysian
Mexican
Dutch (Netherlands)
New Zealander
Nigerian
Norwegian
Pakistani
Peruvian
Filipino
Polish
Portuguese
Russian
Saudi Arabian
Singaporean
South African
South Korean
Spanish
Swedish
Swiss
Thai
Turkish
Emirati (United Arab Emirates)
British (United Kingdom)
American (United States)
Venezuelan
Vietnamese
Other
Mother's Mobil Phone
*
Mother's WhatsApp Number (if not same as phone)
Student's Siblings
Layout
Name of Sibling #1
Sibling #1 Current Grade
Saudara Sedang Kelas Berapa
Not Yet School - Belum Sekolah
Kindergarten - Playgroup
Preschool A
Preschool B
Grade Kelas 1
Grade Kelas 2
Grade Kelas 3
Grade Kelas 4
Grade Kelas 5
Grade Kelas 6
Grade Kelas 7
Grade Kelas 8
Grade Kelas 9
Grade Kelas 10
Grade Kelas 11
Grade Kelas 12
Name of Sibling #2
Sibling #2 Current Grade
Saudara Sedang Kelas Berapa
Not Yet School - Belum Sekolah
Kindergarten - Playgroup
Preschool A
Preschool B
Grade Kelas 1
Grade Kelas 2
Grade Kelas 3
Grade Kelas 4
Grade Kelas 5
Grade Kelas 6
Grade Kelas 7
Grade Kelas 8
Grade Kelas 9
Grade Kelas 10
Grade Kelas 11
Grade Kelas 12
Educational Background - Latar Belakang Pendidikan
Layout
Name Previous School
Transcript/Report (if any)
Click or drag a file to this area to upload.
Ijazah - Repor Terakhir (jika ada)
Current English Level
*
Tingkat Bahasa Inggris Saat Ini
None - Tidak bisa
Beginner - Pemula
Elementary - Dasar
Intermediate - intermediat
Advanced - Canggih
Native Speaker - Penutur Asli
Final Grading
Certificate of English - Sertifikat Bahasa Inggris
*
YES - ADA
NO - Tidak Ada
English Test Results
Click or drag a file to this area to upload.
Hasil Tes Bahasa Inggris
Student Health - Kesehataan Siswa
Layout
Blood Group
*
Golongan Darah
Don't Know - Tidak Tahu
A-
A+
B-
B+
AB-
AB+
O-
O+
Immunisation Record - Catatan Imunisasi
Click or drag a file to this area to upload.
Has Immunisation Records - Memiliki Catatan Imunisasi
*
YES - Ada
NO - Tidak Ada
Layout
Student is on Medication - Apakah Anak Anda Memakai Obat?
*
YES - Ya
NO - Tidak
Requires Assistance with Medication - Membutuhkan Bantuan Pengobatan
Yes - Ya
Tidak - No
If yes, what assistance is required.
Layout
Allergies - Alergi
*
None - Tidak ada Alergi
Food /​ Makanan
Penicillin /​ Penisilin
Insect Bite/​Gigit Serangga
Other - Lain Lain
If Yes to Allergies, please explain more
Emergency - Keadaan Darurat
Preferred Hospital In Semarang
*
Layout
Name of Emergency Contact (if can not contact parnets)
*
First
Last
Nama Kontak Darurat (jika tidak dapat menghubungi orang tua)
Name of Family Doctor
Relation to Student
Phone Number Emergency Contact
Family Doctor Phone
Info
Layout
Where did you hear about Permata Bangsa School
*
Dari mana Anda mendengar tentang Sekolah Permata Bangsa?
Parent of PBS - Ortu dari PBS
Friend - Teman
Newspaper - Berita Koran
Billboard - Papan Iklan
Social Media - Sosmed
Other - Lain
Other Documention
Click or drag a file to this area to upload.
Dokumen lain bila ada
Location/Source - Lokasi/Sumber
Declaration and Agreement - Deklarasi dan Persetujuan
We declare that the information given on this application form is true and correct.
We agree to conform to the set rules and regulations given by Permata Bangsa School.
We agree to instruct our child to abide by these rules.
We understand and agree that there is no refund of fees once the child has commenced school.
We understand that enrollment is conditional upon the following factors: students' genuine effort in pursuing academic excellence, good behavior, attendance in all scheduled classes, and prompt payment of all fees.
We understand and agree to provide legitimate reasons and supportive evidence when the student is unable to attend classes.
We agree to inform the School immediately of any changes in the above details.
We understand that the School reserves the right to review or change any decision made regarding admission on the basis of incorrect information given on this form.
Kami menyatakan bahwa informasi yang diberikan dalam formulir aplikasi ini benar.
Kami sepakat untuk mengikuti aturan dan peraturan yang berlaku di Permata Bangsa School.
Kami setuju untuk menginstruksikan anak kami mematuhi aturan tersebut.
Kami memahami dan setuju bahwa tidak ada pengembalian biaya dalam bentuk apapun ketika anak kami sudah memulai sekolah.
Kami memahami bahwa proses pendaftaran ini ditentukan oleh beberapa faktor antara lain: usaha siswa dalam mengejar keunggulan akademik, perilaku yang baik, kehadiran dalam semua kelas terjadwal, dan penyelesaian biaya–biaya yang mungkin timbul.
Kami memahami dan setuju untuk memberikan alasan yang sah dan bukti yang mendukung ketika siswa tidak dapat menghadiri kelas.
Kami setuju untuk segera menginformasikan kepada sekolah mengenai setiap perubahan pada detail di atas.
Kami memahami bahwa sekolah berhak untuk meninjau atau mengubah keputusan yang dibuat mengenai penerimaan ini jika informasi yang diberikan pada formulir ini adalah salah.
We declare that the information given on this application form is true and correct
*
YES - YA
NO - TIDAK
Kami menyatakan bahwa informasi yang diberikan dalam formulir aplikasi ini benarKami menyatakan bahwa informasi yang diberikan dalam formulir aplikasi ini benar
Layout
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About PBS
Principal’s Message
Vision & Mission
Facilities
Pathways to Your Future
Why Permata Bangsa School?
Virtual Tour
Academics
Early Years
Playgroup
Preschool A
Preschool B
Primary
Secondary
High School
Admissions
Guidelines
School Fees
Registration Form
Inquiry form
Uniform Guides
Handbook
School Information
News
Events
Photos Gallery
Videos Gallery
Academic Calendar
Edu Page
PBS Community
Student Council
Parent Committee
PBS Alumni
Contact Us