Child's Name (English) *
First Last
Child's Name (Chinese) *

Gender *
Boy Girl
Date of Birth *
DD MM YYYY

Parent's Name *
First Last
Relationship with Child *

Contact Number #1*

Contact Number #2*

Email *

Address *

Class to apply *
Village: 0 - 1.5yr
Our Time: 1.5 - 3yr
Course No. *

Please refer to Class & Fee Schedule for course numbers, schedule, venue and fee.

Apply for Discount Incentive Plan ?
Early Bird Discount
Sibling Discount
Bring-A-Buddy Discount
Please refer to Discount Incentive Plan & Installment Plan for discount plans available.

How did you heard of "Kindermusik with Elly" ?
Friend Internet Newspaper or Magazine Other
Please specify (e.g. friend's name, baby-kingdom.com, google.com, yahoo.com, or other media or publication...)

Message

Declaration *
(1) I understand that Kindermusik with Elly (hereafter named "this program") has the rights to take photos and videos during classes for training reference and promotional use.
(2) I agree that this program can use the abovesaid photos / videos with my child therein in media including but not limited to internet, newspapers and magazines.
(3) I have read, understood and agreed to the Discount Incentives & Installment Plan, Information & Classroom Polices of this program.