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GROOVY EXCELLENT EDUCATION

JAKARTA INTERNATIONAL PRIVATE COURSE


Telp: (021) 7918 4270 Hunting: 0813 8164 0694 & 089694398857
E-mail: studentgee.indonesia@gmail.com
www.jakartatutoring.com

REGISTRATION FORM
Students Data
Name : ______________________________________________________________
Date of Birth : ______________________________________________________________
Address : ______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number: ______________________________________________________________
Email address : ______________________________________________________________
School/Univ. : ______________________________________________________________
Grade/Semester: _____________________________________________________________
Curriculum : ______________________________________________________________
Subjects : ______________________________________________________________
______________________________________________________________
Schedule :
Sun Mon Tue Wed Thurs Fri Sat
Subject
s
Time

Parents Data
Name : ______________________________________________________________
Address : ______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number: ______________________________________________________________
Email address : ______________________________________________________________

Note:
Registration fee (IDR 150000) is transferred into bank account BCA | 2471604382 | Anggi Stefani
Ferdiana before first meeting.
Tuition fee for non-package program must be transferred at last date 30 or 31 every month.
Tuition fee for package program must be transferred at last date 5 every month before first meeting at the
month.

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