LemmeLearn Enquiry Application Form
Thank you for your interest in joining LemmeLearn's program! We would like you to fill out the form below. The details provided will enable us to assist you better and assess the suitability of your child in these sessions.

Lessons will be carried out in English.

Thank you!

感谢您有兴趣参加 线上游戏与活动课程！我们希望您填写以下表格，提供的详情资料能协助我们为您提供更好的服务与帮助。我们的名额有限，可能无法让每个人都加入，但我们会尽力而为。谢谢！

You can reach out to:
Eileen
+60 16-357 3800

or email us at info@lemmelearn.com


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Email *
Name (Parent/Guardian) 姓名（父母/监护人） *
Telephone No.（电话号码） *
Email（电邮） *
Address - specify city and state（住家地址） *
How did you get to know LemmeLearn?（您是如何知道LemmeLearn?） *
Name of Child （孩子的姓名） *
Age of Child （孩子的岁数） *
Diagnosis （诊断） *
When was your child diagnosed? （您孩子诊断日期）
Who was the clinician diagnosed your child? (Name of the clinical psychologist, psychiatrist, pediatrician, etc) Do you have a report? 谁诊断您的孩子 （临床心理师，心理医生，儿科医生的姓名）
Describe your child's strengths (描述您孩子的强项) *
Describe your child's struggles (描述您孩子所面对的困难与障碍) *
Is your child under medication? （您的孩子是否服用药物） *
Has your child ever struggled with anything listed below? (Select all that apply) *
Required
What is your child's current / Highest level of education （教育程度)
What is your child currently doing? (studying, working, etc.) 您的孩子目前的职业 （就读，打工，等） *
What is the goal for your child in enrolling LemmeLearn's session? (您希望家长与孩子能从这课程中学习到些什么？) *
I would like to learn more about the *
Required
Our fees vary from RM1500 to RM3000 per month depending on the program you sign up for. Will you be needing sponsorship? *
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