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+ Health History

Submission of an application does not guarantee admission. All applicants must complete an evaluation process which may include admission tests and interviews.

This form must be completed by the applicant’s parent or legal guardian. All document submissions must be in PDF format.

To be considered for admission, you must submit this application form and all application requirements. At the minimum these include:

    1. School records for the last 3 years
    2. A confidential reference or references
    3. Application fee
    4. Student and/or Parent Questionnaires
    5. For students who require learning support services: Copies of all reports/evaluations relating to the support need

Incomplete or incorrectly formatted documentation will cause delays.
Failure to fully disclose information or falsification of documentation provided may result in denial of admission, withdrawal or enrollment or exclusion from enrollment, and/or possible notification to authorities.


For example: "Allergic to nuts, lips and throat swell, has an epi pen
Write N/A if not applicable

Regular Medications
These are medicines taken on a regular and on-going basis.

Consent to Administer Medication

Please indicate whether you allow your child to receive the following medication if he or she falls ill while at school.

e.g. Claritin

Dietary Restrictions


All students, as a condition for enrollment, must be current on their childhood immunization schedule. At the minimum this includes Polio, Diphtheria, Pertussis, Measles, Mumps, Rubella and Hepatitis B. Students admitted to JIS will need to submit an Immunization and Medical Clearance. If you wish to get started with this requirement prior to admission, click here to download the Clearance Form.

Doctor’s Information
If you do not have a preferred doctor in Jakarta, JIS will contact the nearest hospital or clinic.

Default Text

JIS does not provide, and therefore is not obliged to provide any medical and non-medical coverage for any persons (students or non-students) for injuries or accidents during curricular, co-curricular or extracurricular activities on campus, off-campus locally and off-campus abroad. This also applies to JIS students, JIS parents and volunteers, non-JIS students and non-JIS parents who participate in any JIS event on or off campus.

Parents are required to procure suitable personal health, medical and travel insurance along with any other type of insurance that they may deem necessary, for their child(ren) and themselves before enrolling at JIS.