Registration form
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Email *
Registration date *
MM
/
DD
/
YYYY
Child's Name: *
Father's Name (for child) *
Mother's Name (for child) *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Home Address *
City *
Phone Number (Home) *
Phone Number (Mobile) *
Whatsapp number *
Instagram Account (if none, enter none) *
Facebook Account (if none, enter none) *
School's Name *
Grade *
English Education Goal *
Check all your times available for an EfeX class:
Senin/Rabu
Senin/Kamis
Selasa/Kamis
Selasa/Jumat
1:00-2:00pm
2:00-3:00pm
3:00-4:30pm
4:30-5:45pm
5:45-7:00pm
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