Clone of [LIL' PALETTE] KIDS SPACE MEMBERS FORM WITH PAYMENT

Members Particular Form

Please fill in the form below to complete your onboarding process.
Comoclub No (if any)
Comoclub and KIDS SPACE are separate membership programs, each offering its own unique experiences and perks.
About You
Name of Parent/Guardian (Main Member)*

PrefixFirst NameLast Name
Contact Number*

Area CodeMobile Number
Email Address*
example@example.com
Gender*
Relationship*
Birth Date*

DayMonthYear
DD-MM-YYYY
Nationality*
Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip CodeCountry
Profile Image*

Cancelof
Contact Preference*

PhoneEmailBoth
Do you consent to Photography & Videography for Marketing purposes?*

Your Family
No. of Family Member(s) Registered under this Membership*
Family Member #2 Details
Member Name (2)*

PrefixFirst NameLast Name
Email Address (2)*
example@example.com
Phone Number (2)*

Area CodeMobile Number
Gender (2)*
Relationship (2)*
Birth Date (2)*

DayMonthYear
DD-MM-YYYY
Nationality (2)*
Profile Image (2)*

Cancelof
Family Member #3 Details
Member Name (3)*

PrefixFirst NameLast Name
Email Address (3)
example@example.com
Phone Number (3)

Area CodeMobile Number
Gender (3)*
Relationship (3)*
Birth Date (3)*

DayMonthYear
DD-MM-YYYY
Nationality (3)*
Profile Image (3)*

Cancelof
Family Member #4 Details
Member Name (4)*

PrefixFirst NameLast Name
Email Address (4)
example@example.com
Phone Number (4)

Area CodeMobile Number
Gender (4)*
Relationship (4)*
Birth Date (4)*

DayMonthYear
DD-MM-YYYY
Nationality (4)*
Profile Image (4)*

Cancelof
Family Member #5 Details
Member Name (5)*

PrefixFirst NameLast Name
Email Address (5)
example@example.com
Phone Number (5)

Area CodeMobile Number
Gender (5)*
Relationship (5)*
Birth Date (5)*

DayMonthYear
DD-MM-YYYY
Nationality (5)*
Profile Image (5)*

Cancelof
Family Member #6 Details
Member Name (6)*

PrefixFirst NameLast Name
Email Address (6)
example@example.com
Phone Number (6)

Area CodeMobile Number
Gender (6)*
Relationship (6)*
Birth Date (6)*

DayMonthYear
DD-MM-YYYY
Nationality (6)*
Profile Image (6)*

Cancelof
Payment
Date of Membership Commencement*

DayMonthYear
Please select prefer Start Date (DD-MM-YYYY).
Membership Plan*

Bi-Annual: 6 Months MembershipMonthly: 1 Month Membership
Bi-Annual Payment Type*

Single Payment6 Payment Cycle
prevnext( X )
Bi-Annual Plan6 Months Membership (U.P. $3,900)
$3,120.00SGD Quantity

Monthly Membership Plan1 Month Membership (U.P. $750 per month)
$600.00SGD Quantity

Total

$0.00SGD
Bi-Annual Membership Plan
(6 Payment Cycle)

6 Payment Cycle across 6 months ($520 per month).

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Your Membership Agreement

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By signing below, I agree that I have received, read and understand my rights regarding my membership, payment and cancellation options, and agree to the terms and conditions of this contact:*

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Member Name*

PrefixFirst NameLast Name
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Members Particular Form

About You

Your Family

Family Member #2 Details

Family Member #3 Details

Family Member #4 Details

Family Member #5 Details

Family Member #6 Details

Payment

Your Membership Agreement