Student Registration

TADIKA DUTA IMAN (GELUGOR, PULAU PINANG) (1243307-W)
NO.14, LINTANG PEKAKA 1
TAMAN PEKAKA,
11700 GELUGOR
PULAU PINANG

0103780085

Student Info

Full Name

Name Tag

Maximum 14 characters including space

Primary Phone *

Local International

Please use this format: 0123456789. No dash and space. Include country code if international number.

E-mail

Primary e-mail for communication with SMAP

Address

ID Type

NRIC

Birth Cer No.

Gender

Male Female

Date of Birth

Place of Birth

No. of Siblings

Child No.

Previous School

School Name

Referred From (About Us)

Health Info

Health

Enter if there are allergies, illnesses and medication intake

Father/Guardian Info

Full Name

ID Type

MyKad

Phone

E-mail

Occupation

Employer

Office Address

Office Phone

Salary

Mother Info

Full Name

ID Type

MyKad

Phone

E-mail

Occupation

Employer

Office Address

Office Phone

Salary

Emergency Info

Full Name

Phone

Relationship

Terms and Conditions

Full payment for 2024 Annual Registration Fee to be paid latest by 15 December 2023 or your booking seat will be open to other students.

1 have read and understand Polisi Parents Handbook (https://drive.google.com/file/d/1YeYMibOSCCNDoDCc75qc9wjWopg39mxu/view?usp=sharing) & agreed with AKURJANJI (https://forms.gle/ppvFJ1KCqoG1wept7) provided

I agree to the above terms and conditions

Username