Jl. Teuku Umar Barat 335, Denpasar Barat
+62 361 8466 700
info@hoorayschoolbali.com
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Student Application Form/Formulir Aplikasi Siswa
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Personal Details
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Step
1
of 6
Personal Details/Data Pribadi
Name of child/Nama anak
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First
Last
Age/Umur
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Tahun
Date of Birth/Tanggal Lahir
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Place of Birth/Tempat Lahir
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Sex/Jenis Kelamin
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Female
Female
Male
Religion/Agama
*
Hindu
Hindu
Budha
Islam
Kristen
Nationality/Kebangsaan
Previous School/Sekolah sebelumnya
Next
Family Details/Data Keluarga
Name of Father/Nama Ayah
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First
Last
Date of Birth/Tanggal Lahir
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Nationality/Kebangsaan
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Occupation/Pekerjaan
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Home Address/Alamat rumah
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone No. /No Telp rumah
Mobile Phone No./No handphone
*
Name of Mother/Nama Ibu
*
First
Last
Date of Birth/Tanggal Lahir
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2015
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1926
1925
1924
1923
1922
1921
1920
Nationality/Kebangsaan
*
Occupation/Pekerjaan
*
Home Address/Alamat rumah
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone No. /No Telp rumah
Mobile Phone No./No handphone
*
Previous
Next
Getting to Know Your Child/Informasi Lebih Lanjut Mengenai Anak Anda
Main Language/Bahasa utama
*
Other Languages/Bahasa lain
What sports does your child like playing?/ Olahraga apa yang anak anda sukai?
*
What hobbies and interests does your child have?/ Apakah hobi atau minat dan bakat anak anda?
*
Does your child watch television regularly?/Apakah anak anda menonton televisi setiap hari?
*
If so, in what language?/Jika iya, dalam bahasa apa?
Who does your child sleep with? /Dengan siapakah anak anda tidur?
*
Does your child have any fears?/Apakah anak anda memiliki ketakutan terhadap sesuatu?
*
Eating Habits/Kebiasaan pada waktu makan
Does your child feed him/herself?/Apakah anak anda bisa makan sendiri?
*
Does he/she eat at the table with other family members?/Apakah anak anda makan di meja makan bersama anggota keluarga lainnya?
*
Does your child eat a balanced diet? /Apakah anak anda mengkonsumsi makanan dalam menu diet seimbang?
*
Does your child enjoy eating fruit and vegetables?/Apakah anak anda menyukai buah-buahan dan sayuran?
*
Toilet Habits/ Kebiasaan menggunakan toilet.
Is your child independent in their toilet habits?/Apakah anda mandiri dalam menggunakan toilet?
*
Previous
Next
Academic Ability/Kemampuan Akademis
Reading Ability/Kemampuan membaca
In English/Bahasa Inggris
*
can read sentences/mampu membaca kalimat
can read words/mampu membaca kata
can read letters/mampu mengenali huruf
unable to read/belum bisa membaca
In Indonesian/Bahasa Indonesia
*
can read sentences/mampu membaca kalimat
can read words/mampu membaca kata
can read letters/mampu mengenali huruf
unable to read/belum bisa membaca
In Another Language/Bahasa Lain
*
can read sentences/mampu membaca kalimat
can read words/mampu membaca kata
can read letters/mampu mengenali huruf
unable to read/belum bisa membaca
Writing Ability/Kemampuan menulis
In English/Bahasa Inggris
*
can write sentences/mampu menulis kalimat
can write words/mampu menulis kata
can write letters/mampu menulis huruf
unable to write/belum mampu menulis
In Indonesian/Bahasa Indonesia
*
can write sentences/mampu menulis kalimat
can write words/mampu menulis kata
can write letters/mampu menulis huruf
unable to write/belum mampu menulis
In Another Language/Bahasa Lain
*
can write sentences/mampu menulis kalimat
can write words/mampu menulis kata
can write letters/mampu menulis huruf
unable to write/belum mampu menulis
Mathematical Ability/Kemampuan matematika
Does your child have a good understanding of number?/Apakah anak anda memiliki pemahaman yang baik tentang angka?
*
Is your child able to do basic addition?/Apakah anak anda mampu melakukan penjumlahan sederhana?
*
Is your child able to do basic subtraction? /Apakah anak anda mampu melakukan pengurangan sederhana?
*
Is your child able to do basic multiplication?/Apakah anak anda mampu melakukan perkalian sederhana?
*
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Next
Social Interaction/Interaksi Sosial
Would you say your child relates to other children well?/Apakah anak anda berinteraksi dengan baik terhadap anak lain?
*
Would you say your child relates to other adults well?/Apakah anak anda berinteraksi dengan baik terhadap orang dewasa?
*
Emergency Contact Information/No telp darurat yang bisa dihubungi
Please provide the contact details of people who can be contacted in an emergency if you are unavailable/ Mohon memberikan data no telp darurat yang bisa dihubungi saat anda tidak bisa dihubungi.
Name/Nama
*
First
Last
Relationship to Student/Hubungan dengan siswa
*
Telephone Number/No telp
*
Name/Nama
First
Last
Relationship to Student/Hubungan dengan siswa
Telephone Number/No telp
Document's Attachment
*
Click or drag files to this area to upload.
You can upload up to 12 files.
Max 5MB - JPG, PDF file attachment
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Security Measures/Jaminan Keamanan
Please provide the name(s) of any other person (s) who will be dropping off/picking up your child. Please also enclose a photocopy of their identity card./ Mohon memberikan data nama orangyang akan mengantar atau menjemput anak anda, dengan menyertakan fotocopy identitas diri atau KTP orang yang bersangkutan.
Name/Nama
*
First
Last
Relationship to student/Hubungan dengan siswa
*
Car model and registration number/Jenis kendaraan & no kendaraan
*
Student’s Medical Record/Riwayat Catatan Kesehatan Siswa
Student’s name/Nama Siswa
*
First
Last
Name of paediatrician/Nama Dokter Anak
Contact details of paediatrician/Detail telp Dokter Anak
Please list any medical issues your child may have./Mohon menginnformasikan tentang berbagai macam riwayat medis yang pernah anak anda alami.
Special health conditions/ Kondisi kesehatan secara spesifik
Allergies/Alergi terhadap
Serious injuries/accidents/Kecelakaan atau luka berat
Medication/Obat-obatan yang pernah diberikan
Operation/Operasi
In the event of an emergency I authorize Hooray School to take whatever action is deemed necessary for the health and safety of my child. Note: Hooray School will make every effort to contact an emergency contact before taking action in a medical emergency.
Pada saat keadaan darurat saya mengizinkan pihak sekolah Hooray School untuk mengambil tindakan apapun yang diperlukan demi kesehatan dan keselamatan anak saya. Dengan catatan: Pihak sekolah Hooray School akan berusaha menghubungi terlebih dahulu no telp darurat tersebut di atas sebelum mengambil tindakan darurat yang diperlukan.
Date / Time
*
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2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
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1937
1936
1935
1934
1933
1932
1931
1930
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1928
1927
1926
1925
1924
1923
1922
1921
1920
Parent’s Signature/Tanda tangan orang tua
*
Clear Signature
With a digital signature you agree to any data that you have provided for us to use as a complete registration form.
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