Which Mosque are you interested to register to?
Please Select
Abdul Hamid Kg Pasiran
Ahmad Ibrahim
Al-Istiqamah
Al-Muttaqin
An-Nahdhah
An-Nur
Assyafaah
Darul Makmur
En-Naeem
Hj Yusof
Hajjah Rahimabi Kebun Limau
Yusof Ishak
Alkaff Upper Serangoon
Omar Salamah
Petempatan Melayu Sembawang
Muhajirin
Basic Information
Name as NRIC
*
Gender
*
Male
Female
Marital Status
*
Married
Single
Engaged
Birth Date
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
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1975
1974
1973
1972
1971
1970
1969
1968
1967
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1965
1964
1963
1962
1961
1960
1959
1958
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1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Occupation Status
*
Studying
Working
Both
Contact Details
Mobile Number
*
E-mail
*
Confirmation Email
example@example.com
Emergency Contact
Name of the Emergency Contact:
Relationship with the emergency contact:
Father
Mother
Guardian
Other
Emergency Contact Number:
Other Information
Hobbies / Interests
*
Acting
Badminton
Basketball
Billiards
Bowling
Cake decorating
Candlemaking
Chess/Checkers
Composing
Cooking
Cricket
Cycling
Dancing
Debating
Decorating
Finance
Flower arranging
Football
Gardening
Gymnastics
Hairstyling
Hiking
History
Instrument(s)
Jogging
Marathon
Music
Nutrition
Organizing & Publicity
Painting
Photography
Politics
Singing
Swimming
Table Tennis
Teaching
Tennis
Travel
Volleyball
Woodwork/Carving
Other Hobbies / Interests
Medical Conditions
Please tick 'yes' or 'no' according to your medical conditon
*
Rows
Yes
No
Chest Pain, Coronary Problems, High Blood Pressure
Lung Problems (Asthma, Bronchitis, Tuberculosis, etc.)
Head Injury, Fits Epilepsy, Fainting Attacks, Migraine
Back / Neck Problems
Diabetes
Eye (Vision) / Ear (Deafness) Problems
Arthritis, Bone or Joint injury
Surgery within the last 3 years
Allergies (Drugs, Food, etc.)
Routine Medication Needs
Blood Disorder (eg. G6PD deficiency, thalassemia)
Hospitalisation within last 3 months
If you have tick 'yes' for any field above, please specify and explain further details accordingly:
Special Dietary Needs:
Is there / Do you have any other disability or medical information you wish to highlight?
Submit
Should be Empty: