Intelligent Registration Form

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NRIC Number Front

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Student Information

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NRIC Information

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Date Of Birth

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Parent Information

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Phone number is required.

Email address is required.

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Terms and Regulations

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Course Enrollment

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Class Start Date *

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1 分娩方式 Mode of delivery

自然Vaginal birth 剖腹产Caesarean section 早产Premature birth

2 孩子出生时有任何状况吗？Any characteristics during delivery?

无No 有Yes

缺氧Cerebral hypoxia 胎粪吸入Meconium aspiration 心脏有孔A hole in the heart

3 孩子有脑部方面的医药记录吗？Are there any medical records of brain?

无No 有Yes

4 孩子有换过左右手吗？Have you ever changed your child's writing hand?

无No 有Yes

5 孩子有暴力倾向吗？Does he/she have violent behavior?

无No 有Yes

很少Seldom 偶尔Sometimes 经常Always

6 孩子曾经有发生过以下状况吗？Have he/she ever had the following symptom(s)?

抽筋Cramp 哮喘Asthma 时常发烧Often Fever 晕Dizzy 呕吐Vomit 酸痛Muscle Pain 敏感、过敏（红、肿）Allergy (Skin Rash, Swelling)

中文家长同意书

家长同意书

本人〔身份证号码：〕同意让小儿/小女〔身份证号码/报生纸号码：〕参与的感统培训课程。

本人了解院方将做足安全措施，并了解于培训课程期间若有意外发生，实非双方所愿。因此，倘若小儿/小女在培训课程期间有任何损伤，本人将不会对院方采取任何追究的责任。

EN Parent Consent Letter

Parent Consent Letter

I, (ID / NRIC Number No: ) hereby grant my permission for my son/daughter (NRIC Number No / Birth Certificate No: ) to participate in the Sensation Station Programme at the centre of .

It is understood that with any activity there is chance for accidents. I understand that the company will put the emphasis on safety precautions. I acknowledge that the company and I are not willing to see any accidental or unpredictable event. Therefore I further agree that I will not make any claims against, sue or attach the company for any bruises or injuries resulting from my son/daughter participation in the training.

家长签名：

Signature of Parent/Guardian

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签署日期：

Date of Signature

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