Geniekids Program Registration Form:
Kindly print, fill up, attach payment (cheque in favour of "Geniekids") and send the form to us through
courier or hand delivery. Also send us a email stating that you have done so and we will promptly acknowledge on receipt.

Name of Child :

Mother’s Name

Date of Birth:

Housewife/ Working

School:

Company/ Profession

Class:

Mother’s e-mail

Child’s email:

Fathers’s Name
Home Address:

Company/ Profession

Father’s email

Phone Nos:  Res                                                         Office                                           
Mobiles:

Program

Participant Name

Age Group

No of Weeks

First Date

Last Date

Amount

Cash/ cheque

Receipt No (office use)
                 
                 

Send to: GenieKids Learning Resources Pvt. Ltd., No 18, 16E Main, HAL 2nd Stage, Bangalore- 08
Ph 2520-2510 ; E-mail: ratnesh@geniekids.com website: www.geniekids.com