Workshop Registration
Complete the form below to register for the workshop.
Information of Child
Full name of child (as in identifying documents e.g., NRIC or Passport)
*
Date of birth
*
-
Day
-
Month
Year
School
Grade Level
Address
Street Address
City
State / Province
Postal / Zip Code
Has your child been to counselling, therapy or assessment?
Yes
No
If yes, please indicate when and reason(s), as well as any diagnosis:
Emergency contact
Full name of Parent
*
Contact number of Parent
*
Email
Back
Next
Main objectives/goals of attending the workshop:
*
How did you hear about this workshop?
Please Select
Google search
Facebook
Instagram
Friends/Relatives
Therapist
Poster
Others
Terms and Conditions
Will you like to be informed of any upcoming workshops? If so, your email will be placed on our distribution list.
Yes
No
Signature of Parent
*
Full name of Parent
*
Date
*
-
Day
-
Month
Year
Submit
Should be Empty: