15/10/2025 - Emas Preloved

SCHOOL REGISTRATION FORM

Tahfiz Khalifah • Didik Diri Mulai Di Hati

No Pendaftaran: -

Hubungi +6019-229 6464
TahfizKhalifah@gmail.com
Bandar Baru Bangi

Information

Registration Number (Auto)

Auto ikut bilangan pendaftaran.

Registration Received On (Auto Tarikh & Masa)

Diisi automatik berdasarkan peranti/telefon pengisi borang.

Student Information

Name (Nama Pelajar) *

Student ID

Date of Birth *

Home Address *

City

State

Zip Code

Gender *

Male Female

Previous School (if any)

Guardian Information

Guardian Name *

Relationship to Student *

Other

Phone Number (Penjaga) *

Email Address

Home Address (if different from student)

Emergency Contact Information

Emergency Contact Name *

Relationship to Student *

Phone Number *

Medical Information

Does the student have any allergies?

Yes No

If yes, please list

Does the student have any medical conditions we should be aware of?

Yes No

If yes, please specify

Primary Physician Name

Phone Number

Health Insurance Provider

Policy Number

Consent & Agreement

I certify that the above information is correct to the best of my knowledge. *

Documents Submitted

Birth Certificate Immunization Records Proof of Address Other

If Other, please specify

Date (Auto)

Signature (Tandatangan) *

Tandatangan guna jari/pen.

Flow: Tekan Hantar → sistem akan download PNG borang lengkap (siap sign) → WhatsApp terbuka. Sila attach PNG dalam WhatsApp sebelum hantar (WhatsApp tak boleh auto-attach dari web).

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