MUSIC TOTS
Register by 30th November 2017 to enjoy a free trial on 16th December 2017
Starting 20th Jan, 27th Jan, 3 Feb and 10th Feb 2018
Participant's name *
Your answer
Gender *
Diagnosis, if any
Your answer
Date of birth *
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Fees ( Inc. GST)
Payment Details
Payee: Oasis Place Sdn. Bhd.
Bank: CIMB
Account no: 800 711 3565
Kindly forward remittance copy to events@oasisplace.com.my
Sibling's name (if sibling is also joining the sessions)
Your answer
Current Address
Your answer
Home phone number
Your answer
Mother's name *
Your answer
Mother's mobile number *
Your answer
Mother's email address *
Your answer
Mother's occupation
Your answer
Father's name *
Your answer
Father's mobile number *
Your answer
Father's email address *
Your answer
Father's occupation
Your answer
Primary contact person
Your answer
EMERGENCY Contact #1 Name *
Your answer
Relationship *
Your answer
Current medications *
Your answer
Seizures *
Remarks (if any)
Your answer
It is compulsory for the TODDLER to be accompanied by at least ONE parent at all times. *
Required
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