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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)
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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(B) PARTICULARS OF PARENTS / GUARDIAN (CONTINUED) * circle where applicable Mother's name (Underline Surname)
Address (if different from child’s particulars)
Postal code
Occupation :
Passport / IC / FIN No.: Handphone/ office tel. nos.
Email:
Company's name & address * Mother's Highest qualifications :
'O' levels/ 'A' levels/ Diploma/ Degree/ Masters/ others :
Postal code
Guardian's name (Please complete if child is not living with parents)
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
(C) IN CASE OF EMERGENCY, PERSON TO CONTACT( other than parents/guardian) * circle where applicable Name as in passport / NRIC
Address
Postal code
Telephone (Home) Handphone / office no. ext.no (if any) Relationship to child (eg, aunt, uncle, godparents etc)
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(D) PERSONS AUTHORISED TO FETCH YOUR CHILD * circle where applicable Name as in Passport / NRIC
NRIC / FIN No.: Relationship to child (eg, aunt, uncle, godparents, helper etc)
Hp No:
Preferred Session ( NS to K2) : * AM / PM Session Roots & Wings Programme : * K1 / K2
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
Updated November 2018