Online Student Registration Form - Genius Aulad Online Centre
Registration Information
Application For School *
For Intake Year *
For 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) :  
Untitled Document
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
Others Information
How do you know about us


I, here with agreed that all information given is correct. Genius Aulad has the rights to reject without prior notice. 
I hereby agree to put my child under the care of above center in the duration and vicinity of the preschool session. I understand that while the center is trying to maintain its best care of the child, the company should not be held responsible for any ailments and accident within time frame of the session. Thank You.