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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: bprk@bpmc.com.sg 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