CARING MOMS Academy Course Survey Name* First Last Gender*MaleFemaleDate of Birth:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Please answer to the questions below:1. What is your topic of interest to learn from CARING MOMS Academy within the next one year?*2. What is your reason to learn?* a. Earn extra income b. Hobby c. For my children or family d. Other (Enter below) Other (describe here)*3. What skills would allow you to feel more confident ?*4. Which interests or skills would you like to develop?*5. What courses do you think helps you?*6. How do you like to learn?* Classroom Online 7. Do you prefer weekdays (office hours/after office hours)or weekend classes?* a. Weekdays (9am to 5pm) b. Weekdays (after 6pm) Weekends ( Saturday / Sunday) Privacy*I hereby accept the Terms and Conditions above and understand that advertisements are subject to approval by CARING MOMS. CARING MOMS reserves the rights to reject any advertising request at will. All information collected is inline with the Personal data Protection Act 2010. I also confirm that all information provided above to be valid and true. I Agree PhoneThis field is for validation purposes and should be left unchanged.