1 REGISTRATION FORM (A) PARTICULARS OF CHILD ( Please complete the form in BLOCK LETTERS) * circle where applicable Name as in birth certificate (Underline Surname) Name in Chinese ( if applicable) *Birth certificate / FIN No.: Nationality ADDRESS (Block, Unit no., Street, Building name) Postal code * Male / Female Date of birth (dd/mm/yy) * Family Religion: Christianity / Buddhism/ Telephone No. (Home/Hp) Race : Hinduism / Islam / Others: No. of children in family Position of child in family (eg.2 nd child) Language spoken at home Child’s medical history (eg Asthma, Epileptic fits, Allergy, etc) _____________________________________________ _____________________________________________ Name of siblings previously or currently with the school ___________________________________________ ________________________________________ Any food allergy / special diet (please specify) : (B) PARTICULARS OF PARENTS / GUARDIAN * circle where applicable Father's name (Underline Surname) Address (if different from child’s particulars) Postal code Occupation Passport / IC / FIN No.: Handphone/ office tel. nos. Ext. no (if any) Company's Name & Address Postal code Father's email address: BETHESDA (PASIR-RIS) KINDERGARTEN 11 PASIR RIS DRIVE 2 SINGAPORE 518458 TEL: 6585-0346 FAX: 6585-0347 Email: [email protected]www.bprk.sg Paste a passport size photo of your child here
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size photo of REGISTRATION FORM · PR Certificate or Dependent's Pass (if child is not a Singapore Citizen) Child's Immunisation Record I consent to the use of my child's photos
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REGISTRATION FORM (A) PARTICULARS OF CHILD ( Please complete the form in BLOCK LETTERS) * circle where applicable
Name as in birth certificate (Underline Surname)
Name in Chinese ( if applicable) *Birth certificate / FIN No.:
Nationality
ADDRESS (Block, Unit no., Street, Building name)
Postal code
* Male / Female Date of birth (dd/mm/yy)
* Family Religion: Christianity / Buddhism/
Telephone No. (Home/Hp)
Race : Hinduism / Islam / Others:
No. of children in family Position of child in family (eg.2nd child)
Language spoken at home
Child’s medical history (eg Asthma, Epileptic fits, Allergy, etc) __________________________________________________________________________________________
Name of siblings previously or currently with the school ___________________________________________ ________________________________________
Any food allergy / special diet (please specify) :
(B) PARTICULARS OF PARENTS / GUARDIAN * circle where applicable Father's name (Underline Surname)
Address (if different from child’s particulars)
Postal code
Occupation Passport / IC / FIN No.: Handphone/ office tel. nos. Ext. no (if any)
Preferred Session ( Pre-NS) : * AM / PM Session I would need school bus services : * Yes / No * Circle one only
I certify that the details are to the best of my knowledge, true and correct. I attach the following items to the registration form: Copy of child's birth certificate Copy of mother's IC /Passport Copy of father's IC /Passport 1 passport-size (colour) photo of child Deposit and registration fees (inclusive of GST) PR Certificate or Dependent's Pass (if child is not a Singapore Citizen) Child's Immunisation Record I consent to the use of my child's photos/ videos taken in school for our advertisement & website use. __________________________________ ______________________ Name Date
Signature of Parent / Guardian* Kindly inform us when there is a change in address, telephone number or handphone numbers etc. FOR OFFICIAL USE 1. School Fees by: * Cash/ Cheque/ CDA-baby bonus (applicable only after 1st payment by cash/cheque)
2. Commencement Date : ____________________ PARENT / GUARDIAN’S ACKNOWLEDGEMENT AND CONSENT FORM INSURANCE FORM