Student Care Registration Form HPPS

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*
Primary Level*
Class*
Does your child have special educational needs (SEN)?*

YesNo
If yes, please indicate your child's SEN below.
Leave blank if not applicable.
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
Primary Level
Class
Does your second child have special educational needs (SEN)?

YesNo
If yes, please indicate your second child's SEN below.
Leave blank if not applicable.
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
Primary Level
Class
Does your third child have special educational needs (SEN)?

YesNo
If yes, please indicate your third child's SEN below.
Leave blank if not applicable.
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
Primary Level
Class
Does your fourth child have special educational needs (SEN)?

YesNo
If yes, please indicate your fourth child's SEN below.
Leave blank if not applicable.
Address
Postal Code
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)*
Citizenship*
Home No.
Mobile No.*
Marital Status*
Marital Status (Others)
Leave blank if not applicable.
Email Address
Father's Particulars
Father's Full Name (as per NRIC)*
NRIC (last 4 digits)*
Citizenship*
Mobile No.*
Marital Status*
Marital Status (Others)
Leave blank if not applicable.
Email Address
Are you currently receiving or having applied for Financial Assistance Scheme (FAS) from the school?*

YesNo
Reason for applying for Student Care*
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.

Kindly note that SCC teachers are not trained to manage students with serious special educational needs (SEN).
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

Accident Plan

Declaration