IBDCI Member Registration Form
Step
1
of
3
33%
Branch 分院
(Required)
Location of Branch
Please Choose
Johor- Adda Height
Johor- Eco Botanic
Johor - Skudai
Johor -Taman Gaya
Johor- Segamat
Johor- Kulai
Sarawak - Miri
Melaka- Melaka
Penang - Jelutong
Perak- Ipoh
Perak - Ipoh Botani
Sabah - Sandakan
Selangor - Bukit Tinggi
Selangor - Kepong
Child's Name 孩子姓名
(Required)
Gender 性别
(Required)
Male
Female
Birth Cert / IC No. 身份证号码
Date of Birth 出生日期
DD slash MM slash YYYY
Age 年龄
School 学校
Place of Birth (出生地方）
Special illness & Needs 特殊疾病与需求
No
Other
Service 课程服务
(Required)
Please check with us before you enter the information. 请先与我们确认再输入资料
Kidstart Baby Course
Kidstart Junior Pre 1
Kidstart Junior Level 1
Kidstart Junior Level 2
Kidstart Primary Level 3
Kidstart Primary Level 4
Other
T-Shirt size 衣服尺寸
Please try the T-shirt and choose the right size. 请试穿衣服确认尺寸
28
30
32
2XS
XS
S
M
L
To be confirmed 稍后再确认
Parent's Name 家长姓名
(Required)
IC No 身份证号码
H/P No 手机号码
(Required)
Tel No 联系号码 2 (Optional)
Date of Birth 出生日期
DD slash MM slash YYYY
Gender 性别
Male
Female
Place of Birth (出生地区）
Address 地址
Email 电邮
Emergency Contact Person 紧急联系人
Emergency Contact No 紧急联络号码
Declaration
By signing below, I attest that all information indicated herein is true and correct to the best of my knowledge, and I agree to be bound by the rules and regulations of the International Brain Development Certified Institute.本人于下方签署，即声明以上所提供的所有信息都是真实及正确的，并同意接受国际脑力开发认证学院会员的规章制度。
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