STUDENT REGISTRATION FORM

学生背景 Student’s Profile

姓名 Name: (中) ______________________ (英) _____________________________ 年龄 Age: __________

出生日期 Date of Birth: ____________________ 身份证号码 NRIC No: ______________________________
性别 Gender: _____________ 种族 Race: _______________________ 宗教 Religion: __________________
地址 Address: ______________________________________________________________________________
__________________________________________________________________________________________
学校 School: ________________________ 学校班级 Class in School: ______________
父亲 Father
姓名 Name (Eng): _____________________________ 身份证号码 NRIC No: _________________________
职业 Occupation: _______________ 电话 Tel/HP: _________________ 电邮 Email: _____________________

母亲 Mother
姓名 Name (Eng): _____________________________ 身份证号码 NRIC No: _________________________
职业 Occupation:_______________ 电话 Tel/HP: ________________ 电邮 Email: _____________________

监护人 Guardian
姓名 Name (Eng): _____________________________ 身份证号码 NRIC No: _________________________
职业 Occupation: _______________ 电话 Tel/HP: ________________
电邮 Email: ___________________________

兄弟姐妹的人数 No. of Siblings: __________

姓名 Name: ________________________________ 年龄 Age: ________
姓名 Name: ________________________________ 年龄 Age: ________
姓名 Name: ________________________________ 年龄 Age: ________
如有紧急事故，应该联络谁？Person to contact in case of emergency:
姓名 Name: ___________________________ 关系 Relationship: ___________________
电话 Tel/HP: __________________________
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同意书 Acknowledgement

本人 家长/监护人于
I ___________________________________, the parent/ guardian of __________________________________,
身份证号码 已参阅 Sim 的条规，
IC Number ___________________________, have read and agree to all the terms and conditions stipulated,
并同意与给予合作。
and shall give my full cooperation to the centre.

________________________ _______________
Signature of Parent/Guardian Date

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如何知道 SIM 补习及安亲？How do you know about Sim tuition/daycare?

 朋友 Friend  亲戚 Relative  邻居 Neighbour  报章 Newspaper  布条 Banner/传单 Flyer

 社交媒体 Social Media (Facebook)  其他 Others _____________

(FOR OFFICE USE)

Date Joined: _________________ Class in Sim: ________________

No. 科目/ Subject 学费/ Tuition Fees Remarks

1. 报名费 / Registration Fees
2. 书费 / Book Fees
3. 车费 / Van Transport Fees
4. 补习费 / Tuition Fees
5. 日托 / Daycare
6. 电脑班 / Computer Course
7. 绘画班 / Art Class
8. 华语作文班/ Chinese Essay
9. 国语作文班/ Malay Essay
10. 英语作文班/ English Essay
11. 国语特别班/ BM Cikgu Lim
12. 英语拼音班 Phonics Class
13. 其它课程 Others extra class
14. 中学补习/ Secondary Tuition
15. 假期班 Holiday Program
Total RM

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 补习方面 TUITION

学校名次 School Ranking: (全班 Class) ________ (全级 Standard) _________

分数 Result/Mark:
a) 国语理解 BM Pemahaman _______ e) 英文 English _______
b) 国语作文 BM Penulisan _______ f) 数学 Mathematics _______
c) 华语理解 BC Pemahaman _______ g) 科学 Science _______
d) 华语作文 BC Penulisan _______

如犯错，却不接受劝导，可以处罚吗?
Could the tutor punish the student (if the student is at wrong and refuse to listen to the tutor)? YES / NO

载送 Transport/Van service: YES / NO 载送地点 Location: _______________________________

If yes, please tick one:  来回 Return  只来 Pick-up from home  只回 Send home

安亲方面 DAYCARE

会自动自发做功课吗？Ability to do homework independently YES / NO

皮肤/食物/药物有敏感吗？Allergy: Skin / Food / Medication YES / NO

说明 If yes, please specify: ________________________________

如顽皮，可以处罚吗? Could the teacher punish the student (if the student is naughty)? YES / NO

学校有课外活动吗？Does the child have any school extra-curriculum activities? YES / NO

说明 If yes, please specify: __________________________________________

家长几点来接回? Pick-up Time: ____________________

载送 Transportation/van service:
从家里载来 Home to Centre YES / NO
从学校载回来 School to Centre YES / NO
从 Daycare 载去学校 Centre to School YES / NO

星期六有来 Daycare 吗? Saturday daycare service YES / NO (certain area only)

星期六载送 Saturday transportation service YES / NO (certain area only)

备注 Remarks:
 毛巾每天带来/回 及处理衣服 Students have to bring their own clean towel and clothing for change each day.

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TERMS & CONDITIONS 服务条款:
A. Fee 学费
1. All fees shall be paid within the 1st week of each month, and it is not refundable.
学费须在每个月的第一个星期内交清。所有支付的费用一概不退还，包括报名费及杂费。

2. All fees are not negotiable/refundable if student is absence due to illness, family vacation or other reasons.
本中心将不会做出任何收费调整或扣除安亲、补习费及车费于患病，缺席或任何其他原因的学生。

3. Registration fee is applicable to new student, and those who have withdrawn but re-register after 3 months.
新生须付报名费（一次）.如果离开中心，三个月后重新加入必须再次付报名费.

4. Material fee will be collected twice a year, i.e. 1st half (December-March) and 2nd half (April-November).
一年须付两次的书费 （上半年十二月至三月及下半年四月至十一月）。

5. Material fee is inclusive of books and photocopied materials (exercises, notes, assessment test, etc).
书费包括补习书及考卷。

6. 1st half material fee (of the following year) has to be paid in October of the current year for those who wish to
continue. 2nd half material fee has to be paid in April.
本中心将于十月份收新学年上半年的书费及在四月份收下半年的书费。

7. All fees, inclusive of daycare, tuition, transportation and registration fee are not refundable upon withdrawal from
tuition and/or daycare class (midway).
如学生半途停止补习与安亲， 所有的学费， 安亲费，书费， 车费，报名费， 新的补习书本和考卷一律不
得要求退还。

(a) If student withdraws from tuition class in November or April, new tuition books/materials (for half of the year),
which have yet to be distributed, will not be returned to the student; however, the material fee paid will be
refunded.
若学生于 11 月份或 4 月份停止安亲或补习，本中心将全额退还上半年或下半年书费，半年的新书本不
得领回。

(b) If student quits tuition class outside the month of November and April, the tuition books/materials completed
midway will be returned to the student; however, new tuition books/materials (for the rest on the year) will not
be given and material fee will not be refunded.
若学生于 11 月份及 4 月份以外的月份停止安亲或补习，正在使用的书本作业可领回，然而，其余接下
来所将分派的新作业及所交付的学费一概不退还。

8. Fees (daycare, tuition and transportation fees) for 1 st half of November will be collected in August, while 2nd half of
November fees will be collected in September. All fees collected are not refundable.
本中心将在八月收十一月份（ 前半月）及九月份收十一月份（ 后半月）的学费及车费， 所有已交的学费
不得退还。

9. There will be a charge of RM 20 per hour for student (who does not engage daycare service) who stays back at the
centre after tuition/daycare class for more than 30 minutes. The extra payment can pay by cash in the same day or
pay together with monthly fee on next month.
学生如没参与安亲班，且当天课程完毕后逗留在本中心超过半小时将以 RM20/1 小时计算。该收费可选择
当天现金付款或下个月与学费一同支付。

10. There will be an extra charge for student who comes for full-day daycare during school holiday.
学校假期来全日制安亲的学生将有额外收费。

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 11. As exam revision classes are conducted before school examination, there will be NO tuition class after school
examination for 1 to 2 days in Semester 1 to 3, and 2 weeks in Semester 4.
学校考试期间，本中心将增设额外温习班给学生，因此本中心会在第一学期至第三学期考试后停补习 1-2
天及第四学期考试后，即 11 月份停补习 2 个星期，以让学生们有充分休息。

B. Daycare 安亲
1. Parent/guardian should prepare 1-week of clothing (5 sets) and towels (5 pcs).
家长必须准备一星期(5 套)的衣物及(5 条)毛巾。

2. All worn clothing and used towel should be taken home daily.
所有衣物及毛巾必须每天带回。

3. Please prepare and get your child to bring his/her own toiletries (shower cream, shampoo, etc).
请自备沐浴露及洗发精等用品。

4. Parent/guardian must inform the centre should the child/student have allergy towards any food and
medication.
如学生对某种食物和药物敏感， 家长必须事先通知本中心。

C. Public Holidays 公共假期

1. Parent/guardian is advised to take note of the centre’s annual public holidays and examination off-days.
请家长留意本中心所分发的全年公共假期及考试后休假的通告。

2. The centre will be closed on gazetted public holidays and ad-hoc (sudden) declared holiday/s by government and
Chinese New Year. Kindly refer to our public holiday calendar as attached.
本中心将遵守所有的公共假期，以及政府临时所宣布的特假，同时也将在华人农历新年期间暂停。请参考
Sim 所规定的假期列表.

D. Emergency 紧急治疗
1. Parent/guardian is required to give the centre a consent letter or written notice, permitting the child to be treated by
a medical practitioner/clinic (appointed by the parent/guardian) in the event the child falls ill or requires emergency
treatment. The centre will not be liable for any damage or accident that caused the child to suffer, within or
outside of the premise area.
家长/监护人都必须同意并允许生病或需要紧急治疗的学生，接受本中心所指定的医生治疗，而本中心将
不承担学生的任何损失或意外于本中心以内及外之范围； 如有指定医生或诊所，请提前给予书面通知。

2. Please do not send your child to the centre if he/she is sick or has an infection (such as chicken pox, measles,
conjunctivitis, hand-foot- and-mouth disease) until and unless he/she is fully recovered.
如发学生有感染疾病， 请暂时勿带学生到本中心直到康复为止 (如：水痘，红眼症，手足口蹄 症等等)。

E. Holiday Intensive Class 额外假期班

1． Fees are not deductible or refundable if student is absent from the class.
本中心将不会做出任何收费调整或扣除补习费及车费于缺席的学生。

2． New student has to pay the registration fee and tuition (holiday intensive class) fee upon registration.
所有新生须付报名费及所有的费用。

3． All fees are not refundable after registration.

一旦报名，本中心将不会做出任何收费调整或扣除补习费及车费。

4． Fees will not be deducted or refunded if the student withdraws midway, before the completion of the course.
如学生半途退出，所有的费用一律不得要求退还。

F. Others 其它
1. Students are not encouraged to wear any valuable jewelry and bring electronic dictionary, MP3 player, handphone,
electronic (computer) tablets, PSP video game and other valuable items. The centre will not be responsible for any
loss or damage.
学生是不鼓励配戴任何真假的珠宝首饰， 或携带电脑辞典，MP3 播放机，手机， 平板电脑，PSP 电子游
戏机等。本中心将一概不负责任何的损失或遗失.
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 2. The centre must be informed and updated on any change of address or telephone number of the parent/guardian.
家长/监护人必须立即通知本中心关于任何地址或电话号码的更换。

3. Parent/guardian is not allowed to reprint Sim’s extra-curricular books/papers/notes/exercises to non-Sim students.

家长不可擅自把本中心特设的课外书及考卷翻印给不是本中心的学生。

4. The centre reserves the rights to expel student who violates the rules and regulations of the centre.
本中心有权开除任何违反本中心规则的学生。

Personal Data Consent Clause

By submitting this Form, you hereby agree that Sim Educare & Learning Sdn Bhd (“the Company”) and/or its branches
may collect, obtain, store and process your personal data that you provide in this form for the purpose of reference and
considering your feedback as described in this Form, and/or for receiving updates, news, promotional and marketing mails
or materials from the Company and/or its branches.

You hereby give your consent to the Company and/or its branches to:-
a) store and process your Personal Data;
b) disclose your Personal Data to the relevant governmental authorities or third parties where required by law or for legal
purposes.

In addition, your personal data may be transferred to any branch, under Sim Educare & Learning Sdn Bhd which may
involve sending your data to a location outside Malaysia. For the purpose of updating or correcting such data, you may at
any time apply to the Company to have access to your personal data which are stored by the Company and/or its branches.

For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including
all data you had disclosed to the Company in this Form.

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