HEARTS@78A Registration Form

Blk 78A Lorong Limau #01-01

Singapore 321078

wfsc@kkcs.org.sg

6326 0300
Thank you for your interest in signing your child up for the HEARTS@78A Children's Club! Please feel free to speak to our Membership IC Ms. Siyan at 6326 0300 if you need further clarification before signing up. If not, you may proceed to fill in the registration form below.
Membership Registration Form 2023/24
Parent/Guardian's details

Please input the details of the main contact person for your child/children.
Today's date:*

DayMonthYear
Full Name*
Relationship to child*
E.g. mother, father, guardian
Address*
Phone Number*
We will use this number to keep you updated of HEARTS@78A activitiesFormat: 00000000.
How did you hear about us?*
Children's Details

Please input the details of all the children whom you wish to sign up for HEARTS@78A membership. New rows will automatically appear for you to add more children where needed.
Child 1
Name*
Gender*
Date of birth*

DayMonthYear
Remarks*
E.g. allergies, special needs etc
Child 2
Name
Gender
Date of birth

DayMonthYear
Remarks
E.g. allergies, special needs etc
Child 3
Name
Gender
Date of birth

DayMonthYear
Remarks
E.g. allergies, special needs etc
Child 4
Name
Gender
Date of birth

DayMonthYear
Remarks
E.g. allergies, special needs etc
Child 5
Name
Gender
Date of birth

DayMonthYear
Remarks
E.g. allergies, special needs etc
Child 6
Name
Gender
Date of birth

DayMonthYear
Remarks
E.g. allergies, special needs etc
Indemnity Agreement and Consent for Collection, Use and Disclosure of Personal Information

Please acknowledge the clauses below. You may contact us at 6326 0300 for further clarification.
Yes
2) I agree that WFSC may collect, use and disclose my and my children's personal data as provided in this registration form. I understand that my personal data will only be used for the purposes of the HEARTS@78A programmes, e.g. contacting the children's parent/guardian to provide information on upcoming activities. I understand that the personal data will be stored securely within encrypted devices belonging to Kampong Kapor Community Services, and unauthorized personnel will not have access to them.*

Yes
Yes
YesNo
I, parent/guardian's full name*, declare that I have read and understood the above clauses, and that the information provided in this form is true and accurate to the best of my knowledge.
Signature of Parent/Guardian*
Should be Empty:

Membership Registration Form 2023/24

Parent/Guardian's details

Children's Details

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Indemnity Agreement and Consent for Collection, Use and Disclosure of Personal Information