Tadika Ceria Min

Class Information

KN 4 YEARS OLD (8:30AM – 12:30PM) RM395 K1 5 YEARS OLD (8:30AM – 12:30PM) RM395 K2 6 YEARS OLD (8:30AM – 12:30PM) RM395

Student Information

Child Name* Middle Name* Father Name*

Birth Details

Birth Date* Mykid No/Passport No* Birth Certificate* Nationality* Gender*

Address Information

Street Address* Street Address Line 2 City* State / Province* Postal / Zip Code*

Immunization and Health Information

Is your child immunized?* Does your child have any allergies?* If yes, please list, including food or drug allergies: Does your child have any medical conditions?* People authorized to pick up your child (other than parents):

Father’s Information

Father’s First Name* Father’s Middle Name* Father’s Last Name* Father’s MyKad No/Passport No* Father’s Nationality* Father’s Mobile Contact* Father’s Company Name* Father’s Position* Father’s Work Address* Father’s Work Contact Number*

Mother’s Information

Mother’s First Name* Mother’s Middle Name* Mother’s Last Name* Mother’s MyKad No/Passport No* Mother’s Nationality* Mother’s Mobile Contact* Mother’s Company Name* Mother’s Position* Mother’s Work Address* Mother’s Work Contact Number*

Emergency Contact Information

Person to Contact for Emergency (Other than Parent)* Emergency Contact Work Contact Number* Emergency Contact Relationship*

How did you know us?

Family Friend Facebook Instagram Other

Confirmation Page

With the completion of this registration form, you will receive WhatsApp from us shortly.

Please prepare & bring the following documents:

Copy of MyKid
Copy of Birth Certificate
Copy of Immunization Record
Copy of MyKad (both parents)

I certify the information I provided on and in connection with this form is true and correct to the best of my knowledge.

Registration Form