PRE REGISTRATION FORM 2025

Kindly fill in the form and you will receive information related to the Registration Process and Fee Structure via emails Insya ALLAH within 2 to 5 working days
We respect the confidentiality of the information given. It is solely for the usage of Tadika Lestari Impiana and the company Little Caliphs International Sdn Bhd. [Please contact us if you have NOT received any feedback after 5 working days]
STUDENT'S PARTICULAR
Full Name (according to IC)
Student IC No
Gender	Male Female
Home Address
Date of Birth (dd/mm/yyyy)
Place of Birth
Age (on year of enrollment)	4 years 5 years 6years
Nationality
Please select your option	Full day (7.30am - 6.00pm) Half day (7.30am - 1.00pm)
Total of siblings
and the student is the	first second third fourth fifth youngest
Does your child has health condition e.g. asthma or allergies? Please specify
For health condition, please specify severity, if any	1 (mild) 2 3 4 5 (severe)
Does your child has been immunized? [If YES, please submit a copy of his/her immunization record (Jadual Program Imunisasi Kebangsaan) together with other required documents later]	Yes No
Favourite food / drinks
Attended previous school? Please select the options	Kindergarten Playschool Daycare center(taska) No. Staying with nanny No. Staying with parents/guardian
Please specify the name of the institution if you selected 'kindergarten'/'playschool'/'daycare centre'
PARENT'S / GUARDIAN'S PARTICULARS
Father's Name
Father's IC No.
Father's Contact No.
Father's Email Address
Nationality
Race
Father's Occupation
Father's Workplace Address
Mother's Name
Mother's IC No.
Mother's Contact No.
Mother's Email Address:
Nationality
Race
Mother's Occupation
Mother's Workplace Address
EMERGENCY CONTACT INFO (**other than parent / guardian)
Full name (Emergency Contact)
Contact No.
Relation with the student (e.g. grandparents, aunty, uncle), please specify
Name of siblings of TLI's ex-student or currently at TLI (if any)
Remark