STUDY SKILLS 2016 Form

Chill N Champ

PHOTO

Champ No:________

Name: (in Capital)

Age:

Your School Name:

Date of Birth:

Class:

Nationality:

Male

Father's Name:

Female

Father's Mobile No.:

Father's Office Name:

Designation:

Mothers Name

Mothers Mobile No.

Residence No.:

Email:

P.O.Box No.:

(Dubai / Sharjah/Abu Dhabi)

Course Duration: (Joining Date)

till

Would you require transportation? (if yes, draw a map on the back side.)
How did you come to know about us? Flyer

Radio

Facebook

Youtube

School

Friend

Kindly giveTWO references whom you think can benefit from this camp.
NAME

CONTACT

NAME

CONTACT

Medical
Is your child on any medication?

Yes

No

Does your child suffer from any allergies? Yes

No

Please list information below

1 Week

Particulars (Sun Thu)

9:00AM 1:00PM

1.)COURSE FEE
2.

Amount (Dh.)

AED 399
Transportation & Other Fee

2.A) Dubai

AED 100

2.B.)Jebel Ali / JBR / Arabian Ranches etc.

AED 125
AED 25

2.C.) Own transport students

3.) T- shirt
4.)Course material
5.)Registration fee

AED25
AED25
AED 50

Total

Policy: 1)If Refund before joining the course AED 100/- will be deducted. 2) If refund after joining the course for a day minimum 1
week fee will be deducted.
3)Photos/Videos of your ward will be posted on facebook and other Social Media as a matter of self confidence building.

Interestede in Brain Mapping

YES

NO

Signature of the Parent

... rFor Office Use Onlyr ...

..
Date

Receipt
No

Amount

Date

Receipt
No

Amount

Date

Receipt
No

Amount

TRANSPORT DETAILS
Name of the Student:

Champ NO.

Mobile No.: (For Miss Call)

Land Line:
Area:

Route Map