Spiny Babbler

  

EDUCATION FOCUS FORM ACM08

ARTS CLUB MEMBERSHIP
 
ARTS CLUB MEMBERSHIP ENROLLMENT FORM
 
 
I.
Participant Name:    
  First Name    Middle Name   Last Name             
Educational Institution:
Educational Level: Starting Date:     
      Day     Month      Year
Email Address:
Phone:
Birth Date:    
  Day      Month        Year
Country of Origin:
   
Is this your first involvement with Spiny Babbler? Yes No
If not, please mention other forms of involvement.
 
List similar courses attended elsewhere.
   
II.  
Mother or primary guardian's name:
Email Address:
Phone:
Do you want to sign up for the program e-newsletter? Yes No
   
Father or secondary guardian's name:
Email Address:
Phone:
Sign up for the program e-newsletter? Yes No
   
Participant's residence:
 
III.
List medical conditions that SB educators need to be aware of . Eg. diabetes, asthma, recent Hepatitis (jaundice) occurrence, epilepsy. Please note the participant's regular doctor/clinic's name and phone number if available.
In cases of conditions like asthma, show each time (in case of a young child) where mendicants such as inhalers are kept.
   
List several allergies that SB educators need to be aware of. Eg. food conditions, fur, motion sickness, etc.?
In case the participant has several allergies, please supply at least 2 tablets of anti-allergens prescribed by participant's doctor.
 
List behavioral specifics that educators need to be aware of. Eg. very quiet, boisterous, hits other children, etc.
 
IV.
Please tick the chosen course title.
Course Selection Course Title Sessions Hours
SYSM08 Six-year Strengthening Up to 60 a year Max. 200 a year
AAM08 Up to 60 a year Max. 200
QAM08 12 36
QAAM08 Quickies Min. 10 36
 
Transportation request:
Two way, pick up and drop off Area Location:
One way, pick up Kathmandu
One way, drop off Lalitpur
None Out of Ring Road
 
Submition Date:
      eg. 22-Dec-2007
 
 
 
Notes:
1. If you need support in filling up this form, contact our education officers or the front desk.
2. Please type or write clearly (all capitals) on the form.
3. Note that Spiny Babbler courses are quality oriented with limited availability of seats, register early to assure that your seat is booked for the session.
4. Be sure that you keep a copy of this registration form.
 
Download this form in printable format.
For further information
Email: education@spinybabbler.org
Call 5542810, 5546725 Monday to Friday 9 to 6 except on government holidays.
Visit www.spinybabbler.org/education
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