ONLINE STUDENT REGISTRATION FORM -
Registration Information
Application For School *
For Intake Year *
Level *
Preferred Session* Preferred Session Will Be Finalized By Management
Previous School
Student Information
Student Name*
Citizen
IC No/Passport* (No Space and Dash '-')
Birth Cert. No
Birth Place* Others
Birth Date*
Gender/Race/Religion*
Tel. Mobile* (Parent) (No Space and Dash '-')
Email (Parent) Eg. mel@yahoo.com
Tel. Home
Address (Line 1)*
Address (Line 2)
City*
Postcode* Others
Illness/Alergic

 Others (Specify) :  
Guardian / Father Information
Name*
IC No / Passport*
Relation*
Occupation
Salary* (RM)
Education
Employer
Address
Tel. Mobile (No Space and Dash '-')
Tel. Home
Tel. Office Fax:
Email Eg. mel@yahoo.com
Mother Information
Name*
IC No / Passport*
Relation*
Occupation House Wife (Click)
Salary* (RM)
Education
Employer
Address
Tel. Mobile (No Space and Dash '-')
Tel. Home
Tel. Office Fax :
Email Eg. mel@yahoo.com
Family Information
  Name School/College/Job Birth Year
1.
2.
3.
4.
5.
6.
7.
8.
For Emergency Contact (Beside Parent)
 Name*
 Relation*
 Tel. Mobile* (No Space and Dash '-')
 Tel. Home
 Tel. Office
 Fax
 Email Eg. mel@yahoo.com
Other Information
How do you know about us
Untitled Document
G. CHILD DEVELOPMENT HISTORY
Getting To Know Your Child Better Answser Specify
Does your child have any eating disorder / problem? YES NO
Is the child left handed? YES NO
Does the child have any special fears that you are aware of? YES NO
Does the child suffer from any allergy? YES NO
Does the child have any speech problem? YES NO
Does the child have any medical history for any illness / condition? YES NO
Has the child ever been to a dentist? YES NO
Has your child had his/her vision tested? YES NO
Has your child completed all his/her vaccination programmes? YES NO
Is the child prone to accident / falling down? YES NO
Does the child tend to be hyperactive? YES NO
Does the child have any other problems that we should be aware of? YES NO
Is the child is currently attending any other form of educational programmes? YES NO
How would you describe the personality of the child?  

Deklarasi Permohonan

Saya, Ibu/Bapa/Penjaga pelajar diatas, mengesahkan telah membaca dan memahami semua maklumat di atas dan mengesahkan semua makluamat adalah betul. 

NOTA:
Ubestari International Sdn. Bhd. berhak membatalkan permohonan tanpa sebarang notis.

Sebarang pembayaran yang telah dilakukan adalan non-refundable.