DAYSTAR Child Development Centre, Jurong West

Blk 653C Jurong West St 61 #01-460 Singapore 643653

Tel: 67958936     Fax: 67956215

Email: info.jurong@daystar.org.sg

REGISTRATION FORM

DAY CARE ONLY
Preferred Date of Commencement: Commencement Date:
(A) PARTICULARS OF CHILD
Name (as in birth certificate)
Alias
Name in Chinese (华文名) Passport/Birth Cert. No.
Age Country of birth
Date of birth (dd/mm/yyyy) Birth Order
Nationality Race
Gender (Male/Female) Religion
Residential address
Mailing address
(B) PARTICULARS OF PARENTS
Name of Mother Name of Father / Guardian
NRIC No NRIC No
Date of Birth (dd/mm/yyyy) Date of Birth (dd/mm/yyyy)
Ethnic Group Ethnic Group
Nationality Nationality
Highest Educational Level Highest Educational Level
Contact No. Contact No.
Mobile phone Mobile phone
Office Office
Residential Residential
Email address Email address
Residential address Residential address
(if different from above) (if different from above)
Occupation Occupation
Office Address Office Address
How you come to know about us:
(C) SOCIAL INFORMATION
(1) Parents living *together / separated / divorced?
(2) Number of siblings in family
(3) Favourite toys, activities
(4) Parent's method of discipline
(5) Special Instruction:
(a) Behavioural
(b) Food / Diet Restriction
(c) Sleeping
(d) Eating Habits
(e) Toilet Training
(6) Child's Personality
(7) Language Spoken At Home
(8) Current Care Arrangement
(D) RELEASE OF CHILD
The following named individuals are the only persons authorized to pick up my child from the Centre, and Daystar Child Development Centre is indemnified from any damages, claims or other liabilities which might result from Daystar Child Development Centre (it's Employees) releasing my child to me or to any persons named below:
Name Name
NRIC No NRIC No
Relationship to child Relationship to child
Telephone Telephone
I certify that the above details are the best of my knowledge true and correct and will keep the Centre informed of any changes.
Mother's Signature & Date Father's Signature & Date
MEDICAL INFORMATION
(A) TYPE OF VACINATION DATE (DAY / MONTH / YEAR)
(1) BCG (dd/mm/yyyy)
(2) Triple Antigen / Poliomyelities (DPT / SABIN) (dd/mm/yyyy)
(3) Booster
(dd/mm/yyyy)
(dd/mm/yyyy)
(4) Measles (dd/mm/yyyy)
(B) ALLERGY TO
 (Please tick and specify accordingly)
Drugs?
Food?
Others?
(C) IS CHILD
 (Please tick accordingly)
Right Handed?
Left Handed?
Flat Foot?
(D) PHYSICAL DISABILITIES
 (Please write "Yes" or "No")
Speech Hearing
Sight Movement
Others (Please specify)
(E) PAST HISTORY OF INFECTIOUS DISEASE
 (If applicable)
Chicken Pox (dd/mm/yyyy)
Mumps (dd/mm/yyyy)
Measles (dd/mm/yyyy)
German Measles(Rubella) (dd/mm/yyyy)
Others (please specify)
 
 
(F) PAST MEDICAL HISTORY
 (Please write "Yes" or No")
Hare Lips & Cleft Palate
Asthmatic Bronchitis
Epileptic Fits
Congenital Heart Disease
Febrile Fits (related to fever)
Skin Boils
Others (please specify) No
Certificate Checked By : I certify that the details given above are, to the best of my knowledge, true and correct.
Official Parent's Signature & Date
MEDICAL AUTHORIZATION
(a) In the event that I cannot be reached at a time of illness or accident, permission is hereby granted to Daystar Child Development Centre and its
      staff, to call a licensed physician of their own selection or if hospitalization is needed, my child will be sent to the nearest hospital and the
      medical fees and any other expenses such as transportation incurred on behalf of my child will be borne by me.
(b) In such an emergency, when I cannot be contacted, please communicate with:
Name TelephoneNo
Relationship to child:
Address:
(c) I understand that if my child appears ill at the Centre, he/she will be isolated from the other children and placed under staff supervision. I will
      be notified of my child's medical condition and expected to fetch my child from the centre immediately.
(d) I further understand that medication shall be administered by your staff according to the direction given by the licensed physician. The
      medicine shall be in the original container.
GENERAL PERMISSION
(a) I hereby release, indemnify and hold harmless against Daystar Child Development Centre for any accident that may occur to my child while
      he/she is at the Centre.

(b) Permission is hereby granted for my child to participate in any outings (excluding excursions) as you may conduct in connection with your
      Childcare Centre

      I hereby release, indemnify and hold harmless you and your employees, from any damages, claims and other liabilities from such outings.

(c) The cost of any excursion organized by the Centre shall be borne by the parents.
(d) Permission is also granted for my child being included in any picture taken by the Centre which might be used for the purpose of interpreting
      school programs.
I hereby give permission to the above and agree to abide by the rules and regulations as outlined in the Parent's Handbook received.
Signature and Date: