视力防控训练班咨询表格

Vision Management Training Programme Inquiry Form

学生姓名 Student Name *

家长/监护人姓名 Parent/Guardian Name *

电话号码 Phone Number *

电子邮件 Email *

学生出生日期 Student's Date of Birth *

上课地点 Class Location *

KLUANG- Talent Traditional Chinese Medicine No.23,Jalan 10,Taman Sri Kluang, 86000 Kluang ,Johor.

Johor Bahru- 藝樹村生活学习空间 63-02，Jln Eco Cascadia 6/1，Tmn Setia Eco Cascadia，81100 JB

BLOCK 01-03,JALAN HARMONIUM 24/2,TAMAN DESA TEBRAU ,81100 JOOHOR BAHRU

64, JALAN SAGU 8, TAMAN DAYA, 81100 JOHOR BAHRU

课程选择 Class Selection *

儿童班(3至10岁) Kids Class (Ages 3-10)

学生班(8至18岁) Students Class (Ages 8-18)

慧眼班(小孩或成人) Smart Vision Class ( For Children or Adult)

家长同意声明

Parent Consent Declaration

本人确认以上资料填写属实，并同意机构就视力防控训练班相关咨询、课程介绍及后续联系使用上述信息。本人知悉本课程属视力健康管理与训练服务，非医疗诊断或治疗项目。

I confirm that the information provided above is true and accurate. I agree that the center may use the above information for inquiry follow-up, course introduction, and future contact purposes. I understand that this program is for vision care training and management only, and is not a medical diagnosis or treatment service.