BSCC Forms

Bethel Student Care Centre
Blk 114, Aljunied Ave 2, #03-75 Singapore 380114
Tel: 6744 4243 Fax: 6744 5859
Student Enrolment Form
Please tick one:
Student Care Programme
Required Documents:
  • Child's Birth Certificate
  • One recent passport-sized photo of child
  • Both Parent's NRIC
If applying for fee subsidy from CDC (SCFA):
  • Documents to prove parent's income
Section I (Child's Particulars)
Name (As in Birth Certificate):
Name in Chinese Character:
Birth Certificate No.:
Place of Birth:
Date of Birth:
Ethnic Group:
Home Telephone No.:
Home Address:
Name of School Standard/Stream (Pri/Sec/Em):
Session (AM/PM):
Name of Form Teacher:
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 ParticularsMother's Particulars
Name (As in NRIC):
Place of Birth:
Date of Birth:
Ethnic Group:
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:
Contact No.:
Particulars of Guardians (People entrusted to collect the child to and from the center other than the parents; if any):
I/C No.:
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:
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: