VIVA Family Educational Day 2025 Registration Form

We invite you to come join us for the VIVA Family Educational Day

Date: 1st March 2024, Saturday
Time: 2pm - 5:30pm
Venue: Rendezvous Hotel Singapore - 9 Bras Basah Rd, Singapore 189559

We’re pleased to inform you that there will be a dedicated room for children below 12 years old while the talks are being conducted in the meeting room. This will ensure a comfortable and engaging space for the kids, allowing parents and caregivers to participate in the sessions with ease.

Note: If you are feeling unwell, please be thoughtful and excuse yourself from the event

We look forward to seeing you there!

Name *

First NameLast Name

Age*

MaleFemale

A survivor in remissionA patient undergoing treatment in Singapore hospitalA patient not undergoing treatment or in palliative care. (I am Parent/Guardian of a cancer survivor/patient)Other

Parent(s)'s Information

Name*

First NameLast Name

Phone Number

Format: 00000000.

Relationship*

E-mail*

example@example.com

In total how many would be attending the event*

Rows	1	2	3	4	5	0
Adults
Children

How many children are below 12 years old attending the event?*

Does the adult/child have any allergies, or medical conditions? If yes, please describe.

Light refreshment will be provided (No Pork No Lard)

Additional Information/Comments

By submitting this consent form, you agree that VIVA Foundation for Children with Cancer may collect, use and disclose your personal data, as provided in this application form, or (if applicable) obtained by our organisation as a result of your participation, for the following purposes in accordance with the Personal Data Protection Act 2012 and our data protection policy (available at our website: https://www.viva.sg/privacy-policy.html)

(a) the processing of this consent form; and
(b) the administration of the participant for the specific event with our organisation.

Please visit our website at for further details on our data protection policy, including how you may access and correct your personal data or withdraw consent to the collection, use or disclosure of your personal data.

Registration

Patient/Survivor Contact Information