School's Contact No. (Name & Contact No. of School Bus Driver):
School Bus Vehicle No.:
Approximate Arrival Time:
Section II (Parent's Particulars)
Father's Particulars
Mother's Particulars
Name (As in NRIC):
NRIC No.:
Nationality:
Place of Birth:
Date of Birth:
Ethnic Group:
Religion:
Occupation:
Address of Employer:
Office Telephone No.:
Mobile No.:
Email Address:
Section III (Health and Medical Records)
Does your child suffer from:
a. Fits?
Yes
No
b. Asthma?
Yes
No
c. Diabetes?
Yes
No
d. Drug Allergy? (Please Specify)
Yes
No
Does your child have any record of serious accidents, illnesses or hospitalisation? (Please Specify)
Yes
No
Does your child suffer from:
Chicken Pox:
Yes
No
Mumps:
Yes
No
Measles:
Yes
No
German Measles (Rubella):
Yes
No
Others: please specify:
Yes
No
Section IV (Other Relevant Information)
Particulars of Siblings:
Name:
Age:
Gender:
School/Occupation:
Contact No.:
Particulars of Guardians (People entrusted to collect the child to and from the center other than the parents; if any):
Name:
I/C No.:
Age:
Gender Relationship to Child:
Contact No.:
Please provide us with any other information about your child that may be relevant during his stay in the center:
Section V (Declaration and Authorisation)
Name of Parent:
NRIC No.:
Name of Child:
Hereby duly declare that the information i have given in the enrolment form are true and complete, to the best of my knowledge.
I give consent for my child to participate in all activities conducted by bethel student care center, during the child's enrolment in the center
I will not hold the center or its staff liable for any unfortunate accident, injuries, loss of personal belongings or lives that may happen when the child is in the center or taking part in activities organised by the center.
In the event that i cannot be reached at the time of illness or accident, permission is hereby granted to the staff of bethel student care center to send my child for medicial consultation/treatment. Any expense incurred for this event will be bome by me.
Section VI (For Official Use)
Date of Registration:
Date of Enrolment:
Registration Fee:
Receipt No:
Deposit Amount:
Receipt No:
Processed by:
Name of Staff:
Designation:
iCan Magazine was birthed in April 2006 to keep the...
Bethel not only nurtures, embraces, encourages and blends the fundamental of education with moral and social values in their students, but also it guides...