| Name* |
|
| Age* |
|
| Sex* |
|
| Address* |
Flat & Floor |
| Building / Block no. |
| Estate / Street |
| District |
|
|
| Tel no.* (Please provide at least one contact no.) |
mobile phone / pager no. |
| home |
| office |
| Fax no. |
|
| Email |
|
| Name of School/Organisation |
(for school programme or Social Harmony Project only) |
| Name of Programme* |
|
| Date of Programme* |
Day Month Year
(if the programme lasts for more than one
day, please enter the first day of the programme) |
| Time* |
|
| Programme Group |
(if
applicable) |
| Total no. of Participants |
(for family, school programme or Social Harmony Project only) |
| MuseKids no. |
(if applicable) |
| Parent / Guardian (Applicable to
applicants under the age of 18) |
| Name* |
|
| Tel no.* |
|
| Relationship to the child* |
|
| *I
hereby certify that all the information provided is correct and complete. |
|
|
| (*Field required) |
|