Jakarta International Community Center
               
NO REGISTRATION FEE FOR MEMBERS
 
Upcoming Events
 

 

Downloads  

Course Guide :
January, February, March 2012/ PDF
Winter Camp 2011/ PDF
October, November, December 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

 
 

Play Center > Play Center Form

 

Jakarta International Play Center
Age Group 2 - 4 1/2 years

PRE - REGISTRATION FORM

Student's surename

: ________________________________________

Student's first name

: ________________________________________

Date of Birth

d : _______ m : _______ y : _______

Title

: Mr.          Ms.          Dr.          (Please Circle)

Parent's name

: ________________________________________

Address

: ________________________________________

Home phone

: ________________________________________

Handphone No.

: ________________________________________

Office No.

: ________________________________________

Emergency Contact

Name

: _______________________

Home No

: _______________________

Handphone No

: _______________________

Office

: _______________________

I / we hereby confirm that my son / daughter is to be enrolled in the Jakarta International Play Center.

 


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