The Children's House Online Customer Form

Parent Details

*Required fields

First Name *
Last Name *
Contact Number *
Email *
Relationship *
How Did You Hear About Us? *

We have updated our Privacy Policy to align with the Personal Data Protection Act. By providing us information, you give us permission to contact you on updates of our programmes and new centres. For more information, please visit our website or contact our Data Protection Officer at 65017500.

Child Details

Name *
Gender
Date of Birth / Expected Delivery Date *

Visit Details

Preferred Campus *
Preferred Start Date *
Programme
Remarks

Health / Travel Declaration

Please complete this Health/Travel Declaration Form in view of COVID-19, to ensure the health and well-being of our staff and children. Kindly note that a lead time of 14 days may be required (as below) based on your declarations. As health checks will be conducted prior to entry, please reschedule if you have a fever, feel unwell and/or display respiratory symptoms.

Nationality
Please Specify Nationality. *
1. Have you visited China, South Korea, Italy or other COVID-19 affected countries in the past 14 days? *


If Yes, State Country *
and Return Date *
2. Do you have upcoming plans to travel to China, South Korea, Italy or other COVID-19 affected countries? *


If Yes, State Country *
and Return Date *
3. Have you been in close contact with anyone suspected of and/or diagnosed with COVID-19? *

If Yes, Last Contact Date *
4. Have you been in contact with any family member/friend/ visitor/roommate/guest who has travelled from China, South Korea, Italy or other affected countries to Malaysia in the past 14 days? *

If Yes, Last Contact Date *

Kindly be informed that you and your spouse will also be required to submit travel declaration forms onsite before you will be allowed to enter our premises.