A.
STUDENT DETAILS (Parts A to E to be completed by Student/Parent/Guardian)
Full Name as in NRIC:
NRIC No.:
Gender:
School (Name in Full):
Date of Birth:
(dd/mm/yy)
Current School Level:
Email:
Contact No.: (Mobile)
Home Address:
Postal Code:
B.
PARENT / GUARDIAN DETAILS
Full Name:
Relationship with Student:
Contact No.: (Mobile)
Email Address:
C.
Mr
Mrs
Ms
Mdm
Dr
Prof
Occupation:
(Home)
OTHERS / REFERRALS
Do you wish to receive information from us on our activities?
Yes / No
How did you come to know about our organisation?
Word-of-mouth
Website
Facebook
e-Brochure
Others ______________________
Referred by _______________________________________ (Name of person)
__________________________
Signature of Applicant & Date
Bedok Branch: 209 New Upper Changi Road, 03-647
Singapore (460209)
Bishan Branch: 11 Sin Ming Road, Thomson V 2, B2-09
Unit 4, Singapore (575629)
Contact No: +65-91705114