Membership Application Form

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Membership is exclusively for the Owner(s) & Tenant(s) of Elemen

Parent/ Guardian's Name

First

Last

Please ensure this name is the same name as the Sales & Purchase Agreement or Tenancy Agreement.

Layout Layout Parent/

NRIC NO.

e.g. 800801-12-7788. Please ensure this name is the ID No. as the Sales & Purchase Agreement or Tenancy Agreement.

WhatsApp Phone No.

Please ensure the number is correct as it will be your Membership No.

Confirm Email

Member Type

Elemen Unit No.

A copy of stamped Tenancy Agreement or Sales & Purchase Agreement is required if Member Type is Elemen Condo Owner or Elemen Condo Tenant.

Free 3 months trial membership (worth RM750) for a limited time only.
This membership is non-transferable.
Membership benefits and access are subject to the indoor playground's policies, terms, and fair use policies.
For Tenant Type Membership, membership will be terminated upon end of tenancy period.
For Owner Type Membership, membership is to be reviewed annually or 3 months upon expiry.

Management reserves the right to alter and amend terms and conditions and entitlements.

Consent

I confirm that I have read and understood the [Privacy Policy at https://icedino.com.my/privacy-policy. I consent to the collection, use, and processing of my personal information, including my IC number, for the purpose of membership registration, identity verification, and related services provided by Ice Dino / Blue Shuttle Sdn Bhd. I understand that my information will be securely stored and not used for marketing purposes or shared with third parties, except as required by law.
If I am registering on behalf of a child, I confirm that I am the parent or legal guardian of the child(ren) listed and consent to the collection, use, and processing of their personal information for membership registration, verification, and participation in Ice Dino activities. I understand that their information will be handled securely and only used for the stated purposes.

Signature of Parent/ Guardian

Clear Signature

Date

Form version MR1.2 (3-3-2025)