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Kemayoran Blended Learning Students - Emergency Contact Information
Dear Parents, we would like to update our emergency contact information. Please submit this form by Wednesday 9th February 2022.Thank you for your time and co-operation.
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Email
*
Your email
Name of Student / 𝘕𝘢𝘮𝘢 𝘚𝘪𝘴𝘸𝘢
*
Your answer
Class / 𝘒𝘦𝘭𝘢𝘴
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K1
K2
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Level 8
Level 9
Level 10
Level 11
Level 12
SD 1
SD 2
SD 3
SD 4
SD 5
SD 6
SMP 1
SMP 2
SMP 3
SMA 1
SMA 2
SMA 3
Name of Parent 1 / 𝘕𝘢𝘮𝘢 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 1
*
Your answer
Mobile Number of Parent 1/ 𝘕𝘰𝘮𝘦𝘳 𝘏𝘗 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 1
*
Your answer
WhatsApp Number of Parent 1/ 𝘕𝘰𝘮𝘦𝘳 𝘞𝘩𝘢𝘵𝘴𝘈𝘱𝘱 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 1
*
Your answer
Email Address (Parent 1) / 𝘈𝘭𝘢𝘮𝘢𝘵 𝘌𝘮𝘢𝘪𝘭 (𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 1)
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Your answer
Name of Parent 2 / 𝘕𝘢𝘮𝘢 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 2
*
Your answer
Mobile Number of Parent 2 / 𝘕𝘰𝘮𝘦𝘳 𝘏𝘗 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 2
*
Your answer
WhatsApp Number of Parent 2/ 𝘕𝘰𝘮𝘦𝘳 𝘞𝘩𝘢𝘵𝘴𝘈𝘱𝘱 𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 2
*
Your answer
Email Address (Parent 2) / 𝘈𝘭𝘢𝘮𝘢𝘵 𝘌𝘮𝘢𝘪𝘭 (𝘖𝘳𝘢𝘯𝘨 𝘛𝘶𝘢 2)
*
Your answer
Residential Address / 𝘈𝘭𝘢𝘮𝘢𝘵 𝘚𝘪𝘴𝘸𝘢
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Your answer
Drug Allergies of Student (if any)/ 𝘈𝘭𝘦𝘳𝘨𝘪 𝘔𝘦𝘥𝘪𝘴 𝘚𝘪𝘴𝘸𝘢 (𝘫𝘪𝘬𝘢 𝘢𝘥𝘢)
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Your answer
COVID-19 Vaccination Status of Student (if applicable) / 𝘚𝘵𝘢𝘵𝘶𝘴 𝘝𝘢𝘬𝘴𝘪𝘯𝘢𝘴𝘪 𝘊𝘖𝘝𝘐𝘋-19 𝘚𝘪𝘴𝘸𝘢 (𝘫𝘪𝘬𝘢 𝘢𝘥𝘢)
*
Received First Vaccine dose / 𝘔𝘦𝘯𝘦𝘳𝘪𝘮𝘢 𝘥𝘰𝘴𝘪𝘴 𝘝𝘢𝘬𝘴𝘪𝘯 𝘗𝘦𝘳𝘵𝘢𝘮𝘢
Received Dose 1 & Dose 2 of Vaccine /𝘔𝘦𝘯𝘦𝘳𝘪𝘮𝘢 𝘝𝘢𝘬𝘴𝘪𝘯 𝘋𝘰𝘴𝘪𝘴 1 & 𝘋𝘰𝘴𝘪𝘴 2
No Vaccine/ Belum terima atau tidak bisa terima Vaksin
Notes for Emergency Contact/𝘊𝘢𝘵𝘢𝘵𝘢𝘯 𝘶𝘯𝘵𝘶𝘬 𝘒𝘰𝘯𝘵𝘢𝘬 𝘋𝘢𝘳𝘶𝘳𝘢𝘵 (𝘫𝘪𝘬𝘢 𝘢𝘥𝘢)
*
Your answer
I confirm I have provided accurate and up to date information to Universal School via this form. Kami mengonfirmasi bahwa kami telah memberikan informasi yang akurat dan terkini kepada Universal School melalui formulir ini.
*
We have provided accurate and up to date information to Universal School via this form.
Kami telah memberikan informasi yang akurat dan terkini kepada Universal School melalui formulir ini.
Date of Form Submission/𝘛𝘢𝘯𝘨𝘨𝘢𝘭
*
MM
/
DD
/
YYYY
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