Student Care Registration Form NYPS

Student Care Registration Form
Student's Particulars
Full Name (as per birth certificate)*
Child's birth certificate no.*
Date of birth*

DayMonthYear
Date
Gender*

MaleFemale
Citizenship*
Class*
Full name of second child as per birth certificate. (Leave blank if not applicable)
Second child's birth certificate no.
Date of birth

MonthDayYear
Date
Gender

MaleFemale
Class
Full name of third child as per birth certificate. (Leave blank if not applicable)
Third child's birth certificate no.
Date of birth

MonthDayYear
Date
Gender

MaleFemale
Class
Full name of fourth child as per birth certificate. (Leave blank if not applicable)
Fourth child's birth certificate no.
Date of birth

MonthDayYear
Date
Gender

MaleFemale
Class
Address
Postal Code
Home No.
Medical History
Number of members in the household
Is your child currently enrolled in a Student Care Centre?*

YesNo
If Yes, please indicate the name of Student Care Centre
Mother's Particulars
Mother's Full Name (as per NRIC)*
NRIC (last 4 digits)*
Place of birth
Citizenship*
Mobile No.*
Marital Status*
Marital Status (Others)
Leave blank if not applicable.
Occupation
Email Address
Monthly gross income*
Father's Particulars
Father's Full Name (as per NRIC)*
NRIC (last 4 digits)*
Place of birth
Citizenship*
Mobile No.*
Marital Status*
Marital Status (Others)
Leave blank if not applicable.
Occupation
Email Address
Monthly gross income*
Are you currently receiving or having applied for Financial Subsidy Subsidy (FAS) from the school?*

YesNo
Reason for applying for Student Care*
Is there anyone at home during office hours? If yes, please list the guardian's details and their relationship to the child below.
Full Name (as per NRIC)
Relationship
Name
Relationship
Accident Plan
The centre has purchased a basic accident plan for all students in the student care program. However, parents are strongly encouraged to purchase your own accident plan for additional coverage.
Declaration
Please tick*

I do hereby declare that all the above information is true and correct to the best of my knowledge.I will inform Ace@Work should there be any changes to the information above.
Should be Empty:

Student Care Registration Form

Student's Particulars

Mother's Particulars

Father's Particulars

Is there anyone at home during office hours? If yes, please list the guardian's details and their relationship to the child below.

Accident Plan

Declaration