REGISTRATION

Email Address *

Child's Name *

Gender * Select Gender Male Female

MYKID / Birth Certificate / Passport No *

Enter child's position in the family * Position 1 2 3 4 5 6 7 8 9

Date of Birth *

Age * Select Age 6 7 8 9 10 11 12 13

Address *

Contact Number *

Programme * Select Programme (6-9 YEARS OLD) PRIMARY CYCLE 2 3:30 PM (RM 840 PER MONTH X 10 CYCLES) (6-9 YEARS OLD) PRIMARY CYCLE 2 5:30 PM (RM 960 PER MONTH X 10 CYCLES) (9-12 YEARS OLD) PRIMARY CYCLE 3 3:30 PM (RM 960 PER MONTH X 10 CYCLES) (9-12 YEARS OLD) PRIMARY CYCLE 3 5:30 PM (RM 1080 PER MONTH X 10 CYCLES) PRIMARY SPECIAL NEEDS 3:30 PM (RM 1800 PER MONTH X 10 CYCLES) KAFA (RM 240 PER MONTH X 10 CYCLES) TAHFIZ (RM 500 PER MONTH X 10 CYCLES)

Does your child have any special needs ? * Special Needs YES NO

Allergies and Medical History

Has your child went to any other school or kindergarten * YES NO

Previous School *

Why did you choose Madrasati?

How did you find out about Madrasati? *

Is transportation needed? YES NO

Father's Name *

Father's Contact *

Father's Occupation

Father's Work Address

Father's IC Number *

Mother's Name

Mother's Contact

Mother's Occupation

Mother's Work Address

Mother's IC Number

I hereby declare that the information provided is true and correct to the best of my knowledge. I agree to abide by the regulations set by Sekolah Rendah Integrasi Islam Madrasati for my child's interest * YES NO

Signature *