AFFIX A
PHOTOGRAPH
KINDERLAND (TYPHOON KIDS (M) SDN BHD) HERE
KINDERLAND/CHILD CARE ( )
REGISTRATION FORM
INSTRUCTION PLEASE COMPLETE THE FORM IN THE BLOCK LETTERS
*PLEASE DELETE WHERE INAPPLICABLE
* CHILD CARE SERVICE FOR OFFICE USE
Fully Day Care/ Half Day Care STUDENT NUMBER
* KINDERLAND/NURSERY CLASS COMMENCEMENT DATE
1st Session / 2nd Session
(A) PARTICULARS OF CHILD
NAME (Underline Surname)
NAME IN CHINESE (if applicable) PASSPORT/BIRTH CERT NO NATIONALITY
ADDRESS
POSTCODE CITY/TOWN STATE
SEX RELIGION DATE OF BIRTH RACE TELEPHONE (HOME)
MALE FEMALE
CHILD’S MEDICAL HISTORY (e.g Asthma, Epileptic Fits, Allergy, etc)
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
(B) PARTICULARS OF PARENTS/GUARDIAN
FATHER’S/GUARDIAN’S NAME
OCCUPATION TELEPHONE (OFFICE) EXTENSION IC/PASSPORT NO
OFFICE ADDRESS
MOTHER’S NAME
MOBILE PHONE (1) MOBILE PHONE (2)
OCCUPATION TELEPHONE (OFFICE) IC/PASSPORT NO
OFFICE ADDRESS
POSTCODE CITY/TOWN STATE
(C) SOCIAL INFORMATION
1. Is your child allergic to any food? ______________________________________________________________________________________________
2. Has your child any particular illness or health problem? ___________________________________________________________________________
3. Briefly describe your child’s personality ________________________________________________________________________________________
4. Parents Living *Together/Separated/Divorced?”
___________________________________________________________________________________________________________________________
(D) RELEASE OF CHILD
The following named individuals are the only persons authorized to pick up my child from the Centre, and Kinderland is indemnified from any
damages, claims or other liabilities which might result from Kinderland (its employee) releasing my child to me or to any persons named below.
(1) Name ______________________________________________ (2) Name ______________________________________________
NRIC No ____________________________________________ NRIC No ____________________________________________
Relations to the child _________________________________ Relations to the child _________________________________
Telephone No _______________________________________ Telephone No _______________________________________
Car Registration No __________________________________ Car Registration No __________________________________
FOR OFFICE USE ONLY
Registration Fees School Fees Supplementary Fees Uniform Others
Amount paid
O/R No
Date
MEDICAL AUTHORIZATION
a) I understand that in the event of an illness or accident to my child, Kinderland Child Care Centre (“Kinderland”) will
make reasonable attempts to contact me. When I am notified. I am required to pick my sick child immediately.
b) I also understand that if my child shows any sign of being ill or unwell. My child shall be isolated from the other children
and giver staff supervision until any arrangement can be made for his/her removal.
c) In the event that I cannot be reached, I hereby grant Kinderland full discretion to consult a licensed physician of
Kinderland’s choice to attend to my child. All medical fees and other expenses shall be borne by me.
d) I further understand that medication shall be administered by Kinderland’s staff according to the directions given by the
licensed physician.
e) I hereby agree not to hold Kinderland liable in any way whatsoever. For the medical treatment provided to my child at
the centre.
f) The person(s) to be contacted in case of emergency are:
(1) Name _________________________________________ (2) Name ___________________________________________
Tel No ________________(O) _________________ (H) Tel No ________________(O) _________________ (H)
Relationship to child: ____________________________ Relationship to child: ______________________________
Address _______________________________________ Address _________________________________________
___________________________________ _____________________________________
GENERAL
a) I hereby undertake to be bound by the rules and regulations stated in the Parents’ Handbook, which I acknowledge
receipt hereof.
b) I hereby grant permiss ion for my child included in any photographs taken by Kinderland for the direct or in
c) I hereby grant permission for my child to participate in any outings as Kinderland may conduct in connection with the
activities of the child care centre.
d) The cost of any such outings; stipulated by Kinderland from time to time, shall be borne by me.
e) I understand that except in respect of death or personal injury caused by Kinderland’s negligence, Kinderland shall not
be liable for any direct or conquential loss or damage. Any medical treatment provided by Kinderland at its expense
shall be discretionary and on compassionate b basis only. Such medical treatment rendered shall NOT be taken as an
admission of liability for any injury sustained.
RULES AND REGULATIONS FOR KINDERGARTEN/CHILD CARE
1. All lees paid are non-refundable or transferable.
2. All school and supplementary fees must be paid before or within the first week of each school term
3. Group Personal Accident Insurance Coverage Scheme is compulsory for all students at group rates
4. Termination in writing must be given to the school one month in advance. Or one month’s fee will be charged in lieu
of notice.
5. The school reserves the right to transfer. Combine or dissolve a class.
6. The school must be notified immediately of any change in address or telephone numbers
7. Registration fee has to be paid if a student wishes to rejoin the school
8. All students are required to put on school uniforms and shoes
9. Permission is also granted for the use of the school photos of students for purposes of publicity and interpreting school
programs
10. The school will not be responsible for any loss/damage of valuable belonging of students (jewellery. Watch etc)
TADIKA & TASKA KINDERLAND
TYPHOON KIDS (M) SDN. BHD.
Address: 4, Jalan Woodword, 30350 Ipoh, Perak, Malaysia.
Telephone No.: 6 05 – 242 8661 / 254 0386
Fax No.: 6 05 – 243 3661
Email: info@kinderland.com.my
Official Website: http://www.kinderland.com.my
http://www.typhoonkids.com.my