Teen and Adult Online Personal Coaching Class Registration

Student's Information

Student's Name*

Student's Age*

Student's IC*

Student's School*

Parent's Information

Mother's Name*

Mother's Phone Number*

Mother's Email*

Occupation

Father's Name*

Father's Phone Number*

Father's Email*

Occupation

Home Address*

Select Primary Contact*

Mother
Father

For billing and invoicing purposes

Survey

Where did you find out about our class?*

What are your expectations from the class?

If Other, please specify:

Other specific important information we should know?

e.g: medical or health info such as allergies or special need

Select Preferred Session

Online Personal Coaching - Teen and Adult*

3 sessions / week - RM 449 monthly+rm9.90 eportal
2 sessions / week - RM 299 monthly+rm9.90 eportal

Preferred Time(GMT+8)*

e.g: 2 session/week 1. Every Monday, 9:00 pm 2. Every Wednesday, 8:00 pm

Preferred Language*

Malay
English

Preferred Teacher*

Ustaz
Ustazah

Payment

Registration & Annual Fees*

Price:

Coupon

Online Personal Coaching Total Fee

note: monthly fees will be invoiced later and an additional Rm9.90 for the learning management system (monthly)

RM 0.00

Payment Method*

Please choose your preferred payment method below:

FPX / Online Banking / Billplz
Credit Card

Credit Card

Card Details

Cardholder Name

Teen and Adult Online Personal Coaching Class Registration

Online Personal Coaching - Teen Adult

Student's Information

Parent's Information

Survey

Select Preferred Session

Payment

PHYSICAL CLASS

ONLINE CLASS