May 20, 2012
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Pre-Registration Questionnaire
Today's date (D/M/Y) :
Child's name (first/last) : Boy   Girl
Birth date (D/M/Y) :
Birth place (city/country) :
Nationality :
  Religion :
Applying for grade :
Child's Language Skills     
: English : Good   Fair   Poor   None
Bahasa Indonesia : Good   Fair   Poor   None
The last school attended (name/city) : 
Father's name :
  Nationality :
Mother's name :
  Nationality :
Home address :
 
Phone: Fax: Email:
Mother's HP:           Father's HP:
Office name & address :
Phone: Fax: Email:
 
Is there anything important we should know about you or your child? Please explain : 
 
  
 
Jl. Sultan Iskandar Muda No. 98 Arteri Pondok Indah - Jakarta 12240
Phone : 021 - 7291777 Fax : 021 - 7292747
admin@sli-edu.org