Ibubapa Memastikan Peningkatan Akademik Anak (IMPAK)

Parents Assuring Students Success (PASS)

State

Ref No.

Registration Form

/ Name:
/ Gender: /Male

/Female

/Work:

../ IC:

/Age:

:
House Address
:

/ :

H/P No

House /Office Tel No

/Male

Children:

/Female

:
Children Studying in Tamil School:

No

Children Name

Standard/Form

School Name

10 .
.
.. 10.00 .
I herewith agreed to participate in this 10 week workshop organized by Tamil Foundation in consideration of
the development in my childs education performance. I understand and will obey all the rules and regulation
of the workshop. I have enclosed RM10.00 as the registration fee.

# / My convenient day & time to attend class:

/ Day

/AM

/ Fri* (Kedah & Johor)

/ Sat / Sun

/PM

: .....................................................
Signature
:
Date:

/ Weekday

...

-------------------------------------------------------------------------Office Usage----------------------------------------------------------------Registration Fee: RM10.00 - YES (

) NO (

) Collected by: . Date: ..

Tamil Foundation Malaysia, No.3, Level 2, Jalan Yap Ah Shak, 50300 Kuala Lumpur
Tel: 03-2692 6533 / Fax: 03-2692 6758 E-mail: tamilaravaariam@gmail.com

Rev: Dec 2015