REGISTRATION FORM
INTERGENERATIONAL LEARNING PROGRAMME (ILP)
Please fill in this form completely and clearly. Forms which are incomplete
and unclear will not be considered for placement into this course.
SCHOOL/ORGANISATION
COURSE
Temasek Polytechnic
Health Matters
PERSONAL PARTICULARS
Name (as in
NRIC):
Date of Birth:
Race:
NRIC No.:
Gender:
(dd/mm/yyyy)
Chinese
Malay
Indian
Male
Female
Others:(specify)
Email Address:
Mobile No:
Work Status:
Language(s)
spoken:
How did you
learn about
ILP:
Committee/
Membership:
Home No:
Employed full time
Employed part time
Unemployed
Homemaker
Retired
Others: (specify)
English
Mandarin
Dialects (if any):
Hokkien
Teochew
Malay
Self-employed
Tamil
Cantonese
Fei Yue Community Services (FYCS)
People’s Association (PA)
Silver Connection (SingHealth)
Others: (specify)
Others:(specify)
RSVP Singapore
WINGS
If you are a member of any Committee (eg. PA) or Voluntary
Welfare Organisation (eg. RSVP), please fill in:
Committee/ VWO Name:
Position/ Membership:
Member Others:(specify)
Have you attended previous ILP:
Yes
No
If Yes, name the ILP and the school it was
held at:
FOR TRAINING PURPOSE
Are you able to attend all sessions:
Yes
No
Are you able to understand and speak simple English:
Yes
No
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REGISTRATION FORM
INTERGENERATIONAL LEARNING PROGRAMME (ILP)
INDEMNITY RELEASE CLAUSE
1. I am aware that there may be risks associated with the programme and I agree to
waive, release, save, any obligations of Council for Third Age (C3A), Family
Central (FC), and Temasek Polytechnic arising from the programme.
2. I shall not hold the Parties and their officers, directors, employees, members, staff,
agents, successors and assigns (the “Indemnified Parties”) liable for any damage
or loss of property or any illness or injury or loss of any kind including loss of life
which may be sustained by me arising from any cause in connection with the
programme.
3. I undertake to indemnify the Indemnified Parties against any claims and damages
by any 3rd party in connection with my participation in the programme, provided
that it is not caused by gross negligence or wilful default the Indemnified Parties.
4. I agree to voluntarily participate in, and be contacted by C3A and FC after the
programme for perception and behavioural study and I also agree to give the
Parties and government agenciesrights to share, use, publicise or publish in print,
broadcast & electronic media, my quotes, works or photographs derived from this
programme without prior permission.
5. I allow the Parties to contact me regarding events, announcements and any other
updates on active living.
6. I shall observe the attached Code of Conduct during and after the ILP.
Date:
© Copyright Family Central. All Rights Reserved.
Signature:
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REGISTRATION FORM
INTERGENERATIONAL LEARNING PROGRAMME (ILP)
CODE OF CONDUCT
The main objectives of the Intergenerational Learning Programme (ILP) are to forge
intergenerational solidarity to build social cohesion, and to promote active living
and enhance mental and social well being among seniors. Hence, to uphold a
positive learning attitude and social behaviour, participants are required to
observe below Code of Conduct during and after the Activity:
1. comply with all relevant laws, regulations, policies and procedures as
set out by the relevant legislation and/or by the school
2. not use unwanted and unwelcomed verbal or physical conduct of a
sexual, abusive, vulgar and/or violent nature, whether by word,
gesture, or any other form of conduct
3. not harass, victimise or discriminate against any person on the basis of
his/her personal attributes, including but not limited to, disability, age,
gender, race, religion, political affiliation, marital status
4. not engage in sales of goods and/or services to the students, unless
with the express consent of the school
5. dress appropriately and act in a way that shows respect for others and
models appropriate standards for students of the school
6. observe the school’s Smoke-free Premises Policy
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