Trial Class Request Form

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Trial Class Request Form

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* Indicates required question

Participant's name *

Your answer

Participant's age *

Your answer

Participant's Date of Birth *

MM

/

DD

/

YYYY

Gender *

Male

Female

Parent's name *

Your answer

Contact number (Eg. 012-1234567) *

Your answer

Email address *

Your answer

How did you hear about us? *

Your answer

Participant's prior coding experience (Yes/No) *

If 'Yes', please list out the course(s) completed.

Your answer

How would you like the class to be conducted? *

Physical class in Kota Damansara (PJ)

Online class

Physical class or online class

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