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Azon Allied Health & Educare Development

Therapy Registration Form

Please complete the form below to register your child for a therapy programme. Fields marked * are required.

Fields marked * are required.

Student's Details

Please follow the identity card or birth certificate.

JPG, JPEG, PNG, PDF · 5 MB
Calculated from the date of birth. You can adjust it.
Gender
Any Physical or Psychological Condition?
Please attach the student's recent colour photograph and a copy of the identity card or birth certificate.

Parent / Guardian's Details

This is how we will contact you.

Residential Address

Country

Emergency Contact

The person we will call if anything urgent happens during a session.

Other Details

How did you hear about us?
Preferred Language for Correspondence Homework, letters and notices
Payment Methods1. Cash. 2. Cheque or postal order made out to Azon Allied Health & Educare Development Sdn Bhd, sent to E-03-22, IOI Boulevard, Jalan Kenari 5, Bandar Puchong Jaya, 47100 Puchong, Selangor Darul Ehsan. 3. Cash or online transfer to Public Bank A/C No: 3239049119, then WhatsApp or send us the transfer slip. Enquiries: 019-297 1431 / 011-1431 0558 · info@azon.my · www.azon.my
Any questions?
E-03-22 IOI Boulevard, Jalan Kenari 5, Bandar Puchong Jaya, 47100 Puchong, Selangor, Malaysia.
019-297 1431  /  011-1431 0558
info@azon.my
www.azon.my

Address

E-03-22 IOI Boulevard, Jalan Kenari 5, Bandar Puchong Jaya, 47100 Puchong, Selangor, Malaysia.

Email

info@azon.my

Telephone

Existing/Registered Client Support Hotline
+6(011) 1431 0558

Child Learning & Development Assessment/
Psychological Service Appointment Booking Hotline
+6(019) 297 1431

Service/Event Inquiry，Non-Profit/Charity & Recommendation
+6(019) 231 7154

Certificates and Licenses

 

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