Enrollment Form

Name *

Salutation *

• Mr
• Mrs
• Mdm
• Ms

Mobile Phone Number *

Email Address

My Child's Name *

My Child's Age *

Date of Birth - Day/Month/Year *

Gender *

• Male
• Female

Diagnosis (if any)

I am interested to enrol in the following services/programme : *Special Education ProgrammeSpecial Education ProgrammeHomeschool ProgrammeEIP Group/Individual ClassDyslexia Remedial ProgrammeOccupational TherapySpeech & Social Skills TrainingBehaviour ManagementOnline Professional Courses for Parents/TeachersWorkshops for Parents/Teachers

Branch

• Seremban
• Puchong

Submit