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Music Programme (Trial)
*IMPORTANT CHANGES*
Trial Group session for Music Tots & Music Kids has been combined as one(1) session on 24th March, 2.30pm - 3.30pm
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Music Tots:
http://oasisplace.com.my/wp-content/uploads/2019/08/Music-Tots-Trial.pdf
Music Kids:
http://oasisplace.com.my/wp-content/uploads/2019/08/Music-Kids-Trial.pdf
I'm interested to join:
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Music Tots (1 - 3 years old) & Music Kids (4 - 6 years old), 2.30pm - 3.30pm
Dates:
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24th March 2020, Tuesday
Participant's name
*
Your answer
Gender
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Male
Female
Diagnosis, if any
Your answer
Date of birth
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MM
/
DD
/
YYYY
Sibling's name & age (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
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Yes
No
Remarks (if any)
Your answer
It is compulsory for the PRESCHOOLER to be accompanied by at least ONE parent at all times.
*
I acknowledge that I've read the above statement
Required
How did you hear of this programme?
*
Social Media (Facebook, Instagram, Twitter, etc)
Search Engine (Google, Yahoo, etc)
Kiddy123
SENIA
Recommend by Oasis Place psychologists/therapists
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