Registration Form


Parent's Declaration:
Parent's Name:
Email Address:
NRIC:
Nationality:
I wish to register my child for the Student Care Centre at:
 I declare that, to the best of my knowledge, all information given below is true.
 
Student's Particulars:
Name of Student:
Age:
Gender:
Class:
School Attending:
Address:
Telephone Number:
Nationality:
Birth Cert No. :
Birth Date:
Medical History & Allergies:
 
Parents' Particulars:
Father's Name:
Age:
Occupation:
Race:
Religion (if any):
Gross Monthly Income:
Office Number:
Mobile Number:
 
Mother's Name:
Age:
Occupation:
Race:
Religion (if any):
Gross Monthly Income:
Office Number:
Mobile Number:
Total Gross Income:
 
Other Family Members:
Names of Other Family Members Staying in Home:
Relationship to Student:
Occupation:
Remarks:
Names of Other Family Members Staying in Home:
Relationship to Student:
Occupation:
Remarks:
 
Type of Home:
 
 
Particulars of Person to Pick Up Student:
Name:
Relationship to Student:
Mobile Number:
Home Number:
 
Other Remarks: