ENROLLMENT

Pre registration

This form will take 10 – 15 minutes to complete. You will need the following information: *Child’s Birth Certificate / Passport No. *NRIC / Passport No. and employment details of Mother / Father / Guardian *All fields have to be filled up. Enter ‘NA’ if not applicable.

CHILD'S PARTICULARS

PARENTS' / GUARDIAN'S PARTICULARS

EMERGENCY CONTACT

MEDICAL HISTORY

GENERAL INFORMATION

  • Step 1
  • Step 2
  • Step 3
  • Step 4
  • Step 5

Select Programme

Programme

Child's Particular

Full Name (as per birth certificate)

Gender

Date Of Birth

Birth Certificate

Place Of Birth

Birth Order

No. Of Siblings

Nationality

Race

Address

Postal Code

Language Spoken At Home

Sibling Information

Has Current Sibling in Centre?

Have you registered another of your children in the Registration?

PARENTS' / GUARDIAN'S PARTICULARS

Father/Mother/Guardian Name (as in NRIC)

NRIC No.

Adress

Postal Code

Home Contact

Mobile

Occupation

Religion

Nationality

Email Address

EMERGENCY CONTACT (in the event that you and your spouse cannot be reached)

Name (as in NRIC)

Relationship

Home Contact

Mobile

Will you be using your Baby Bonus Scheme

EMERGENCY CARE CONTACT (In The Event Of School Closure Due To Unforeseen Circumstances & Epidemic Situations)

Please select

Name (as in NRIC)

Relationship

Address

Postal Code

Email Address

Does your Child Have

If yes, please select

Allergies

Does your child have allergic reactions? E.g. foods, medicine, grass etc.

If yes, Please provide details

Medical Conditions

If you child has any of the above medical condition, please provide details:

Special Needs

Does your child have any special needs / challenging behaviours?

If yes, please provide details

Does your child regularly visit a specialist? E.g. speech therapist, etc.

If yes, please provide details

Medical Emergency

I understand in case of accident or emergency, every effort will be made to contact me/my spouse immediately. In the event that my child requires medical attention, I authorise the school to obtain medical assistance, and agree to pay any medical/transport costs incurred. I understand that I shall not hold the staff/management of LYC Child Care Centre responsible if my child falls ill or suffers an injury while in the Centre or while involved in any activities conducted by Centre, in and outside the Centre.

I Certify That All The Information Given Is True And Undertake To Inform The School Of Any Changes To The Above Information. And I Agree To The Following Permission:

Submitted by

Relationship to child

I have read and agree to

T – G – 1 Plaza VADS,
Jalan Tun Mohd Fuad,
Taman Tun Dr. Ismail,
60000, Kuala Lumpur.

+603 7733 9622
+6012 9654335

enquiry.childcare@lychealth.com

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