Registration Form

Formulir Registrasi

Student's name*

Preferred name

Gender*

Male

Female

Date of Birth (DD-MM-YY)

Nationality*

Previous School

Grade Applying For

Medical Diagnosis (if any)

Allergies (if any)

Other Health Conditions

Medications Currently Taken

Physician’s Name

Physician’s Contact Number

Special Education Need*

Yes

No

Type of Special Needs

Required Accommodations or Support (e.g., assistant, aids, therapy)

Therapies Currently or Previous Undertaken

Full Name of Parent/Guardian*

Relationship to Student*

Occupation*

Contact Number*

Facebook account

Instagram

TikTok

Home Address*

Emergency Contact Name*

Relationship to student*

Emergency Contact Number*

Does the student use the school transportation service?*

Declaration*

I confirm that the information provided is accurate and complete to the best of my knowledge. (Saya menyatakan bahwa informasi yang diberikan adalah benar dan lengkap sesuai pengetahuan saya)

Guidelines Before Filling Out the Form

Please transfer the registration fee of IDR 500,000 to Bank Syariah Indonesia (BSI) account number 7279244251 under the name Lombok Green School.
Silakan mentransfer biaya pendaftaran sebesar Rp.500.000,- ke rekening Bank Syariah Indonesia (BSI) dengan nomor 7279244251 a.n Lombok Green School.
After completing the transfer, kindly send your payment proof HERE
Setelah menyelesaikan transfer, mohon kirimkan bukti pembayaran Anda ke SINI
Ensure all required fields are completed accurately.
Pastikan semua kolom yang wajib diisi telah diisi dengan benar.
Verify the information provided before submission.
Periksa kembali informasi yang diberikan sebelum mengirimkan.
Contact the provided support number for any inquiries or assistance.
Hubungi nomor WhatsApp yang tersedia untuk pertanyaan atau bantuan lebih lanjut.

Panduan Sebelum Mengisi Formulir

INFORMATION

LOCATION

amaq@lombokgreenschool.com

+62877 5341 8104 (klik di sini)

Kedondong, Desa Pringgasela Selatan, Kec. Pringgasela, Lombok Timur, Nusa Tenggara Barat, Indonesia.

Empowering students through nature-based learning and Islamic values.

EDUCATION