JICC-Jakarta International Community Center

Jakarta International Community Center

NO REGISTRATION FEE FOR MEMBERS

Upcoming Events

Downloads

Course Guide :
August, September, October 2011/ PDF
Summer Camp 2011/PDF
April, May, June 2011 / PDF

Membership Form :
MS Word/PDF

Contact Information

Jl. Kemang Dalam X No. E6A
South Jakarta, 12730
p. +62 21 7179 2813 | +62 21 719 22 16
f. +62 21 719 22 16
e. jicc@cbn.net.id / jicc_online@yahoo.com

Choose a Category > Summer Camp 2011> Registration Form & Payment Arrangement

2 1/2 - 4 years
4 - 8 years
9 - 12 years
The Classes
The Friday Adventures
Registration Form & Payment Arrangement
Staff Class

> Registration Form
> Payment Arrangement

JAKARTA INTERNATIONAL COMMUNITY CENTER
SUMMER CAMP

Student's surename

Student's first name

Date of Birth

Mr. & Mrs.

Parent's name

Address

Handphone No.

Office No.

Emergency Contact

_________________________________________

_________________________________________

d :___________ m :____________ y : ________

Mr. / Mrs. / Dr. (Please circle)

_________________________________________

_________________________________________

_________________________________________

_________________________________________

Name
Home No
Handphone No
Office

_____________________
_____________________
_____________________
_____________________

REGISTRATION FORM
13th June - 12th August 2011

I/ we hereby confirm that my son / daughter is to be enrolled in the JICC Summer School Holiday Program.

Medical Information
Drug / Food Allergies________________________
Other allergies or precautions________________

JICC will do their best to take care of kids during session but for unseen accidents JICC will not be responsible

Signature of the Parent Date:
Or Guardian

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