Application

CHILD INFORMATION

First Name

Last Name

Date of Birth

Gender

Male Female

Nationality

Birth Certificate No. / NRIC / Passport No.

Country of Issue

Home Address in Malaysia

Home Country Address (international applicants)

Session

Full Day 7:00am - 7:00pm Extended Half Day 8:00am - 3:00pm Half Day 7:00am - 12:00pm

Meal Option

Meals provided by RTCC Home-packed Unsure

FATHER'S NAME

Full Name

Nationality

NRIC / Passport No.

Mobile Number

Email Address

Employer / Organization

Title / Position

Chat App

WhatsApp WeChat KakaoTalk Other

Chat App Username / Number

MOTHER'S NAME

Full Name

Nationality

NRIC / Passport No.

Email Address

Employer / Organization

Mobile Number

Title / Position

Chat App

WhatsApp WeChat KakaoTalk Other

Chat App Username / Number

GUARDIAN'S DETAILS

Full Name

NRIC / Passport No.

Nationality

Email Address

Employer / Organization

Title / Position

Mobile Number

Chat App

WhatsApp WeChat KakaoTalk Other

Chat App Username / Number

EMERGENCY CONTACT

Full Name

Relationship to Child

Mobile Number

Alternate Phone Number

Does the child have siblings currently enrolled at RTCC or Raffles American School?

Yes No

Sibling’s Full Name

School / Grade

Sibling’s Full Name

School / Grade

Name of Payer on Invoice

NRIC / Passport No.

Email Address for Invoice

Billing Address:

Home Address Office Address

Company-Sponsored

Company SST No. (if applicable)

Has your child previously received any developmental, speech, or behavioral assessment or therapy?

Yes No

If yes, please describe the type of support and provider:

Does your child currently receive any ongoing therapy or specialist support?

Yes No

If yes, please attach relevant reports:

Does your child require prescribed medication during care hours?

Yes No

If yes, please specify medication, dosage, and schedule:

Any additional information Raffles Toddlers Child Care Center should be aware of to best support your child:

Agent Name (enter ‘None’ if not applicable)

Other (please specify)

I confirm that I have read, understood, and agree to the Declaration and Terms & Conditions of Raffles Toddlers Child Care Center.

I confirm that I am the parent/guardian of the child applying for admission to Raffles Toddlers Child Care Center (RTCC), and that all information provided in this application is true, complete, and accurate to the best of my knowledge. By selecting this checkbox, I acknowledge and agree that: Admission of my child is subject to the approval and acceptance of RTCC. Submission of this application does not guarantee admission or the allocation of a place. RTCC reserves the right to request additional information or supporting documents at any time, and I agree to provide such information promptly and fully cooperate with any such request. RTCC reserves the right to deny admission, withdraw an offer of admission, or dismiss a student if any information provided in this application is found to be inaccurate, incomplete, false, or misleading. I agree to indemnify and hold harmless RTCC, its management, employees, agents, and representatives from and against any claims, losses, damages, liabilities, costs, and expenses arising from or relating to any false, inaccurate, incomplete, or misleading information provided by me in connection with this application. By selecting this checkbox, I confirm that I have read, understood, and agreed to the above declaration and the Terms and Conditions of Raffles Toddlers Child Care Center..

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