Quick Registration Form Fill in the details below to complete your quick registration for the Care2Run Weekly Programme. This form is designed for a faster and simpler registration process. CARE2RUN × XD SCHOOL Quick Registration & Waiting List Form Thank you for your interest in our programmes. This form helps us understand you, your child or participant, and the support your family may need so we can respond with care, clarity, and respect. Section 1 Personal Information Tell us who the participant is. We use this information only for programme administration, safety, and support planning. Participant Details Email Participant's Preferred Name Participant's Full Name (as per IC / MyKid / Passport) Nationality MalaysianNon-Malaysian IC / MyKid / Passport Number Non-Malaysians: enter the participant's passport number. Date of Birth Select the date, month, and year from the calendar. Age (current year) Age will be calculated automatically later. Gender FemaleMale OKU Card Number Optional Section 2 Participant Support Profile Help our coaches understand the participant's health, support needs, interests, motivation, and strengths. Health & Support Needs Allergies Optional Description of Super Powers: If any - Special Needs or Physical Disabilities Support currently provided by you or your family Optional Current Support Level Describe current support provided to your child. Choose the level that most closely reflects the participant's current needs. Level 1 - Occasional to Minimal SupportLevel 2 - Minimal to Substantial SupportLevel 3 - Very Substantial Support We would like to learn a bit more about your child: What are your child's interests, motivation, and strengths that you wish us to celebrate during the session? 1. Interests 2. Motivation 3. Strengths Section 3 Parent / Caregiver Information Provide the details of the person we should contact about this registration. Primary Contact Preferred Name Full Name (as per IC / Passport) Mobile / WhatsApp Relationship to Participant --- Select relationship ---MotherFatherGuardianSiblingCaregiverSelf / Adult ParticipantOther General Health & Safety Agreement I agree to help keep everyone safe and to withdraw the participant from the programme when the participant or accompanying family member is infected by, or has had close contact with, a contagious disease. Section 4 Programme Interest & Goals Tell us which programme you are interested in and what you hope to achieve. Programme Interest Care2RunXD SchoolBoth Care2Run and XD School Programme Goals Describe One Important Goal You Would Like to Achieve From This Programme Which Dates Are You Committing To? Please tell us the programme name and your preferred date or date range. Section 5 Programme Details & Payment Upload the programme information you received and, where payment applies, provide the payment receipt. Programme Details Please upload a poster/message photo of the programme you are joining. Upload up to 5 supported files: PDF, audio, document, drawing, image, presentation, spreadsheet, or video. Max 100 MB per file. Payment Method QR CodeBank Transfer DuitNow QR Touch 'n Go QR Name of Organisation: Wildpac Asia PLT (LLP0005833-LGN) Bank: CIMB Bank Account Name: Wildpac Asia PLT Account Number: 800-783-044-8 Please use the participant's full name as the transaction reference. Payment Receipt No payment is required for waiting-list-only registration. Upload a receipt only if you have already paid. Each of our sessions builds confidence, independence, and real-world readiness for both parents and their children. We thank you for your support. Having Trouble paying or adding an Image? Pls WhatsApp to XD School's New Mobile Number: 010-650 0838 : 1. Your Name & 2. Payment Receipt For us to match your payment! Section 6 2026 Indemnity Agreement Please read and accept the full Care2Run & XD School Programme Indemnity Form before submitting. ⚖️ Care2Run & XD School Programme Indemnity Form The agreement covers participation and risk, health disclosures, emergency first aid and medical treatment, emergency contacts, personal data processing, youth protection, brand and intellectual-property terms, photographs and recordings, participant privacy, and insurance arrangements. The online acceptance below applies to the complete indemnity document, not only to this summary. I agree to all the terms stated on the Care2Run & XD School Indemnity Form → I confirm that I have opened, read, understood, and agree to the full Care2Run & XD School Programme Indemnity Form, and I digitally sign this registration as the person completing the web form. Digital Signature Full Name of Person Completing This Form Date Signed Thank you, Prem, Principal Coach Personal: 019-282 0088 Care2Run / XD School: 010-650 0838 www.thexdschool.com
