ACG School Jakarta - Permission Form

Payment status
Permission Forms

ACG School Jakarta
Destination*

Year 12 Collaborative Science Project TripASAC Senior Football Thailand 8-10 March 2026
Team
Prom Parental consent

I GIVE permission for my child to attend PromI understand that if my child violates the rules, I will need to pick them up immediately
Student name (Secondary Camp October 2025)*
ASAC Consent

I agree to let my daughter/son participate in the ASAC competition and responsible for the cost involved
Departure Flight arrangements

Departing with ACG CrewOwn arrangements
Returning Flight arrangements

Returning with ACG CrewOwn arrangements
WSC 2024 Regional Round Seoul Participant*
Years 5 and 6 - Camp to Bogor

Due to be completed by 18 September 2025
Participant Information Form
Student name*
Student name*
Please ensure full name submitted is in accordance to the Passport
Gender

MaleFemale
Student full name as per passport*
for flight booking purpose
A Night in the School Year Level*

Year 3Year 4Year 5Year 6
Secondary Year Level*

Year 10Year 11Year 12Year 13
IBDP Year Level*

Year 12Year 13
Year level*
Student ID*
ACG Student ID
Transport arrangement*
Payment preference*

Bank TransferCredit card payment
WSC Global Round 2025

IDR 20 million deposit

https://checkout.xendit.co/od/WSC25-DPBangkok
ASAC Senior Boys Football Phuket March 2025

Down Payment: IDR 4,000,000

https://checkout.xendit.co/od/ASAC_PHUKET
Kindly submit your payment via Xendit at https://invoice.xendit.co/od/AC
Would you like to receive official Receipt of Payment?*

YesNo
Nationality*
Passport number*
Passport expiry date*

DayMonthYear
Please note that for overseas trip, ideally passport must show 6 month validity from trip departure
Student Passport/KITAS File Upload*

Upload file
Kindly upload photo file with jpg, jpeg, png or gif format. Maximum size 5MB Cancelof
Sample of Passport Scan format
Insurance*

Browse Files
Please share with the school a digital copy of your child’s health insurance or travel insurance for the trip. Cancelof
Parent details

Details of Parent/Guardian completing the consent form
Parent name*

First nameLast name
Phone Number*
Kindly register 2 email address to receive updates on the trip information (especially for overnight trip)
Parent email 1*
example@example.com
Parent email 2*
example@example.com
Emergency Contact Details

Please provide a second contact person (not the parents itself) details for emergency purpose
Name*

First nameLast name
Mobile number*
i.e 0813 8700 7585
Relationship with student*
Family Doctor's Name*
Family Doctor's Phone Number*
Medical Information
Allergies – please note below*
put n/a if not applicable
Medication – if your child will be bringing any medication on the trip, please note the dosage and details below.*
put n/a if not applicable
Any current medication *
Special dietary requirements
Do you grant permission for your child to swim in the hotel/venue pool? (They will be closely supervised by ACG Teachers while in the pool)*

YesNo
Is there anything else we should know about your child that will help us ensure their safety and enjoyment during the trip?
Payment Instructions
Upload payment proof*

Browse Files

Cancelof
Parental Consent and Acknowledgement of Risk
Parental consent

I agree to my son/daughter taking part in the trip and have read the information sheet. I agree to their participation in the activities described. I acknowledge the need for them to behave responsibly.

Acknowledgment of risk

I have read the trip information sheet and I understand that there are risks associated with involvement in school trips and that these risks cannot be completely eliminated. I understand that the School will identify any foreseeable risks or hazards and implement correct management procedures to eliminate, isolate, or minimize those hazards.

I know that I am able to ask any questions of the School about the activities my son/daughter will be involved in, to gain a better understanding of the risks involved. I recognise that participation in such activities is voluntary and not mandatory. My son/daughter understands that s/he may withdraw from the activity if s/he feels at risk. This must be done in consultation with the person in charge.

I understand that the School does not accept responsibility for loss or damage to personal property and that it is my responsibility to check my own insurance policy.
- The five day 12 noon to 5 pm ACG School Jakarta THIMUN conference will be held on Monday 16 November to Friday 20 November 2020.
- The purpose of this form is to enable the School to ensure that optimal staffing levels are provided, the specific needs of participants are met and the educational value and safety of events is maximised.
- Details on these forms will remain confidential to School staff and volunteers associated with supervising activities on the activity.
I am the parent/caregiver of
Name, Year level i.e John Doe, Year 7
I agree to let my daughter/son participate in the excursion under the supervision of ACG School Jakarta.

Yes
By submitting this consent, I agree to the price of 10-12 million and the above guidelines

Yes
Phone number*
Name and relationship to student: 
Main number: 

Backup contact person
Name and relationship to student: 
Phone number: 


Please maks
Is there anything else we should know about your child that will help us ensure their safety and enjoyment during the trip? *
Behaviour Code
On a school trip, you should always be on your best behaviour. We want you to enjoy the experience and be safe. We also want people to form a good impression of the ACG School Jakarta community through your actions, attitudes and behaviour.

Please remember that...
- Normal school rules apply at all times
- You are officially representing ACG School Jakarta
- Instructions from teachers / parent volunteers in charge must always be followed
- Smoking or consumption of alcohol or illegal non-prescription drugs is strictly forbidden
Before the trip you must…
- Supply the organisers with all completed forms, contact details, medical information, etc.
- Comply with advice regarding what to bring

While travelling, you must…
- Meet at the agreed meeting points on time
- Behave sensibly, avoid excessive noise, and respect the rights of others
- Keep areas clean and tidy up your litter

While in a hotel, hostel, guest home, dormitory etc. you must…
- Comply with instructions regarding meeting points, bed-times, etc.
- Treat all facilities with complete respect
- Respect the rights of other users
- Avoid excessive noise
- Treat employees respectfully and with courtesy
- If you notice any damage to facilities, or cause any damage yourself, report it immediately to a teacher

Thank all hosts and trip organisers for making the trip possible and fun for you.
Should be Empty:

Permission Forms

Years 5 and 6 - Camp to Bogor

Participant Information Form

Parent details

Emergency Contact Details

Medical Information

Payment Instructions

Parental Consent and Acknowledgement of Risk

Behaviour Code