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ENROLLMENT FORM

I hereby verify that I am the parent of RISE Indonesia’s student of RISE Language Program

PARENT INFORMATION

Parent’s name : SISCA ANGELA

ID numbers : 1607054603870007
(Attached with Copy of ID/Passport/KITAS)

Nationality : INDONESIAN

Phone number : 082281091599

Email address : siscaangel.dr@gmail

STUDENT INFORMATION

Student’s name : CACA

Place / Date of birth : 7 May 2013

Gender : FEMALE

Nationality : INDONESIAN

Home Address : Jl Palembang Betung ling III KEL Rimba Asam Kec Betung banyuasin

City : Palembang

Mailing Address :

City : PALEMBANG, SUMATRA SELATAN

Current School : SD IT AL Muhibbin

LANGUAGE PROFICIENCY

Mother tongue : INDONESIAN

Other languages : INDONESIAN

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RLP Form last updated 20200604

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ENROLLMENT FORM

RLP Level Registration : Young Riser……./ Primary Riser……/ Riser 2 / Excellent Riser……
Package Registration : RLP+EA / RLP Only / EA Only (circle as applicable)

Default Schedule
RLP Class : Tuesday & Friday / 17.00 EA Class : ……………………………… / …………..
Day Time Day Time

Other than the Default Schedule, every student can book additional class(es) that fit the
student’s specification and package with conditions as follow:
• Additional class(es) must be booked at the latest 1 (ONE) HOUR before desired schedule. RISE
Indonesia can not guarantee the seat availability (first come first served basis).
• If the student is registered for RLP Only, he/she can only book 1 (one) additional RLP class per week.
• If the student is registered for EA Only, he/she can only book 1 (one) additional EA class per week.
• If the student is registered for RLP+EA Package, he/she can book maximum 2 (two) additional classes per
week (1 [one] RLP and 1 [one] EA).
• There will be no consequences in the booking system if the default class(es) is missed.
• If the student misses booked classes twice (non-default class), he/she will not be able to book the
additional class(es) for the following 2 (two) weeks, but still be able to join the default class(es). This
blocking may be opened if the student misses the booked classes due to urgent matters, provided that
evidence is given to the Education Counselor, such as Doctor’s Note, etc.

*Notes:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I am aware that I am responsible to ensure that my child will attend class regularly to enable best learning results.
Parent’s Signature:
Principal’s Signature:

ADDITIONAL INFORMATION ABOUT STUDENT

Please answer correctly

Does the student have any health problems?

If YES, please explain
.................................................................................................................................................................................................................................... Yes No
Does the student take medication regularly?
If YES, please explain
Yes No
....................................................................................................................................................................................................................................

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RLP Form last updated 20200604
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ENROLLMENT FORM

Does the student have any other social and/or emotional issues that
we need to pay attention to? Please explain
Yes No
.............................................................................................................................

I hereby verify that all information I have given above is correct. I understand that if the information about
my
child’s physical, social, and emotional abilities is inaccurate, which results in enrollment cancellation, I will not
ask for refund.

PAYMENT INFORMATION, DISCOUNT, AND PROMOTION

I hereby agree to fulfill all the payment requirements from RISE Indonesia.
A. Course Fee

Course fee and Student Kit are fully paid in advance with the nominal as described by Education
Consultant and agreed by Parent who undersigned this contract, with details as follow:

PAYMENT NOMINAL
Learning Duration
Total Course Fee
Total Discount
Student Kit Fee
Total Payment
Payment Method
*Course Fee is subject to change

B. Installment by Credit Card

TYPE of PAYMENT
TYPE of CARD
0% 0% 0%
BCA 3 months 6 months 12 months
CIMB Niaga 3 months 6 months -
BNI 3 months 6 months -

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RLP Form last updated 20200604
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ENROLLMENT FORM

ACADEMIC OPERATIONAL POLICIES

I have read, understand and accept the Academic Operational Policies outlined below:

● Program Schedule:

1. For each level, the program is held within a period of 6 (six) months and parents are advised to have
their children complete the program in accordance with the time period specified by RISE
Indonesia.
2. For any reason the student cannot attend the class, no make-up class will be given at all levels.
3. Enrolling in the middle of academic year may affect the overall learning outcomes of the academic year.
There is also possibility that the student needs to repeat the same class for next academic year.

● Accident or Injury

Every precaution is taken at RISE Indonesia Centers to provide a safe environment for the children. However,
RISE Indonesia cannot be held responsible for unforeseeable actions of every individual in the center.
Should a child be injured as a result of an accident within RISE Indonesia Centers’ area, the Parent authorizes
RISE Indonesia to give first aid or seek for medical help (if necessary) and all medical expenses occurred
will be borne by the parent.

● Payment Procedures:
1. All payment transactions are done in IDR currency.
2. Payment transactions are considered valid and complete when the payment has been received in
RISE Indonesia bank account.
3. For transaction security, all data must be rechecked before payment transaction is finalized.
4. Payment transaction can be done through BCA Virtual Account, Debit
Card/Check/Giro/Credit Card/Credit Card Installment.
5. Payment by debit card is applied for all debit cards issued by RISE Indonesia’s bank partners.
6. Payment by credit card is applied for all valid credit cards.
7. Payment by credit card installment is valid for BCA, BNI, and CIMB Niaga card holders (terms and
condition applied).
8. Tuition Fee is paid termly (per 3 months) and every month shall be paid in full regardless of
the starting date.
9. The Parent agrees not to ask for any refund, transfer, and/or claim for any payment that have
been made by any reasons.

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RLP Form last updated 20200604
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ENROLLMENT FORM

MEDIA CONSENT

I give permission to publish video/photo/image and personally identifiable information about my child on RISE
official or related media channels and publications (written, digital or events). I also allow RISE official or related
media to repost my content (e.g. from my Instagram, FB) regarding my child’s activities involving RISE Indonesia

I understand that RISE Indonesia wants to showcase the learning and development of RISE students to
communities as part of RISE Indonesia’s responsible and effective communication efforts.

By completing and signing this Enrollment Form, I hereby agree to all the policies and procedures set by RISE
Indonesia. This Enrollment Form is filled in good conscience and not under the influence or force of any other
parties, and is valid throughout the course of my child’s education in RISE Indonesia.

Jakarta, 23 DEC 2020

(Sign : …………………………………………………. ) (Name : ALHAM PRATAMA )

Parent Education Counselor

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RLP Form last updated 20200604