Enrolment Interest Form

3. Medical Conditions
Please share with us your child's medical condition:*

Autism Disorder SpectrumAttention Deficit Hyperactivity DisorderModerate Intellectual DisabilityOther
Any Physical Disability*
If Yes, Please Specify:

5. Current Care Arrangement
Please specify*

Day Activity CentreGrand ParentsHelperHome (Independent)SchoolOther

7. Share With Us
Are you currently a BLUE Chas card holder?

YesNo
How Did You Get To Know About Us?*

FriendFacebookGoogleInformation SessionSG EnableWhatsApp GroupOther

9. Acknowledgement
Terms and Conditions*

By submitting this form, I agree and acknowledge the following:
1. By submitting this, I consent to Connexions contact me regarding my interest

2. Submission of this form does not guarantee placement at the centre. Connexions may request additional information to assess eligibility for my child's enrolment.

3. Providing accurate and complete information is crucial. Any false or incomplete details may disqualify my child's enrolment.

4. I authorize Connesions to use provided contact information for enrolment-related communication and updates
Signature

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Above is Signed & Acknowledge By*
Name of Parent / Guardian
Should be Empty: