Commit Learning SchoolHouse @ Dazhong Primary School - Interest Application Form (Existing SCC Students)

Commit Learning SchoolHouse @ Dazhong Primary School (Primary)

Interest Application Form (for Existing SCC Students)
This Interest Application Form is
FOR STUDENTS WHO ARE CURRENTLY ATTENDING STUDENT CARE IN DAZHONG PRIMARY SCHOOL (PRIMARY) 2024.

Thank you for your interest in Commit Learning SchoolHouse @ Dazhong Primary School Student Care Centre (SCC). Kindly complete this Interest Application Form to register your interest for our student care services.

Please allow approximately 5 - 10 minutes to fill out this form.

Important Notes:

1. Please complete one (1) Interest Application Form for each child/ward.

2. Please ensure that all information provided is accurate and up-to-date.

3. A copy of your submission will be sent to the email address provided within this Interest Application Form.

4. Please be advised that the information you submit in this Interest Application Form will be carried over to the Registration Form for your verification and completion.

During the Registration phase, you may be required to provide additional details not captured in the Interest Application Form for the completion of the Registration.

SECTION: MAIN APPLICANT EMAIL ADDRESS
Email Address:*
Please kindly provide a valid email address for future enrolment correspondence.

SECTION: CHID/WARD PARTICULARS
Please complete the question(s) in this section.
Child/Ward School:*
Child/Ward Full Name:*
(as in Birth Certificate)
Child/Ward Status Selection:

My child/ward is an EXISTING STUDENT CARE CENTRE (SCC) STUDENT and IS ATTENDING student care service in the aforementioned school.
Child/Ward Primary Level in School (in accordance with the year of SCC enrolment):*
E.g. If your child/ward is enrolling into Commit Learning SchoolHouse Student Care Centre in 2025, please indicate your child/ward primary level in school for 2025
Child/Ward Current Class in School:*
E.g. 1A / 1 Respect 2024
Child/Ward Selection of Enrolment into Commit Learning SchoolHouse Student Care:*

I WILL BE ENROLLING my child/ward into Commit Learning SchoolHouse student care in 2025.I WILL NOT BE ENROLLING my child/ward into Commit Learning SchoolHouse student care in 2025, and will be withdrawing my child/ward with the current student care operator by end of 2024.
My Child/Ward has Sibling(s) Who Is/Are CURRENTLY Enrolled in Student Care Services in the Same School:
Please select the total number of siblings currently enrolled in Student Care Services within the same school
First Sibling Full Name:
(as in Birth Certificate)
First Sibling Current Class in School:
E.g. 1 Respect / 1-A (for 2024)
Second Sibling Full Name:
(as in Birth Certificate)
Second Sibling Current Class in School:
E.g. 1 Respect / 1-A (for 2024)
Third Sibling Full Name:
(as in Birth Certificate)
Third Sibling Current Class in School:
E.g. 1 Respect / 1-A (for 2024)
Child/Ward Nationality:

Singapore CitizenSingapore Permanent ResidentOthers (Please Specify)
Child/Ward Date of Birth:

DayMonthYear
DD-MM-YYYY
Child/Ward Gender:*

MaleFemale
Medical Conditions / Medical Allergies / Dietary Allergies:
Please indicate clearly on the medical condition(s), and provide details of any medical precautions and medication/medical aid required for child/ward condition(s).

SECTION: SPOUSE PARTICULARS
Please complete the question(s) in this section.

- If NOT APPLICABLE, please proceed on to the next section (leave section blank)
Name of Parent/Guardian:
(as in NRIC)
Relationship to Child/Ward:
Contact No.:
(Mobile)
Nationality:

Singapore CitizenSingapore Permanent ResidentOthers (Please Specify)
Marital Status:
Employment Status:
Occupation:

SECTION: QUESTIONAIRE
Please complete the question(s) in this section.
Total Gross Household Income:*
(Sum of monthly income from work and other sources of income from all Household Members)
Family is Under/Receiving Welfare Assistance from Social Service Office(SSO)/Family Service Centre(FSC)/Other Welfare Organization:*

YesNo
Please indicate the name of Social Service Office(SSO)/Family Service Centre(FSC)/Organization:
Total Number of People Residing In Same Household:*
(Excluding domestic helper, if any)
Domestic Helper within Residence:*
Alternative After School Care Arrangement Should Student Care Be Not Available for Child / Ward:*

ParentsSiblingsDomestic HelperGrandparentsOthers (Please Specify)

SECTION: DECLARATION
Please complete the question(s) in this section.
By signing this Interest Application Form, I:

a. Declare that the information provided in this Interest Application Form is accurate and up-to-date.

b. Acknowledge that my child / ward interest application may be void if the information provided in this Interest Application Form is found to be untrue.

c. Agree that Commit Learning SchoolHouse may collect, use and disclose my personal data, as provided in this Interest Application Form, for the
purposes in accordance with the Personal Data Protection Act 2012:
- the processing of this application form;
- the administration of enrolment related matters.

d. Agree to all terms as indicated within this Interest Application Form.
Signature*

Clear
Should be Empty:

Commit Learning SchoolHouse @ Dazhong Primary School (Primary)