• A. STUDENT'S DETAILS

  • Select from date from drop down
  • B. PARENT'S DETAILS

  • Father's mobile contact
  • Mother's mobile contact
  • C. AGENT(IF ANY)

  • D. DECLARATION

    In consideration of Epsom College in Malaysia (“ECiM” or “the College”) agreeing to allow my child to participate in this programme, I agree to the following.

    1. I am aware that the programme involves physical activities and I am responsible to take the necessary insurance coverage.
    2. I acknowledge that I am required to disclose all pre-existing medical conditions of my child via the online Student Medical Form (to be provided by ECiM) in order for the College to provide the best possible care to my child during the programme.
    3. I agree that my child is expected to enter fully into the life of the College and to take part in all the programme activities. He/she is subject to the same school rules and disciplinary procedures as the College pupils as per the terms and conditions of this programme.
    4. I will not hold ECiM, including teachers and other staff, liable for any loss or damage suffered by my child during the programme unless the same is caused by negligence or default of an ECiM representative.
  • Please Fill In Full Name
  • Date Format: DD slash MM slash YYYY