Application form for classes: Simply Loving

Simply Learning

Simply Living

File No: ______________________

Name: ______________________________

Birthdate: ______ ______ _______

Day

Address: _____________________________
______________________________________

Month

Gender: M F

Year

Contact no: ________________________ (Home)

________________________ (Mobile)

Email Address: _______________________

Family members:
1) Name________________________________ Birthdate: ______ ______ _______ Gender: M
F
2) Name________________________________ Birthdate: ______ ______ _______ Gender: M
F
3) Name________________________________ Birthdate: ______ ______ _______ Gender: M
F
4) Name________________________________ Birthdate: ______ ______ _______ Gender: M
F
Medical/Emergency Information
Emergency Contact Name/Telephone no. :

Do you have any allergies, medical conditions, dietary requirements, physical restrictions or individual needs?
YesNo
If Yes, please give full details.
Name: ______________________________________________________________________________________
Allergies _____________________________________________________________________________________
Medical conditions ______________________________________________________________________________

2
Dietary requirements _____________________________________________________________________________
Physical restrictions/ Individual needs _________________________________________________________________

Course Enrolment Schedule:

Simply Loving Programme for family of 3 4 people 4 classes $_______________
(English/Chinese Instruction; alternate Saturday; duration 1 hour 30 mins)
Morning 10 11:30 am

Afternoon 2:30 4pm

Evening 7 8:30 pm

Simply Learning Programme for individual young learners (small class of 6 8)

K3-P1______
P2-P3______
P4-P5 _______
4 classes $ ______________ (English Instruction; alternate Saturday)
Morning 10 11:30 am
Simply Living Programme
Payment:

Cash

_________________

Cheque

Afternoon 2:30 4pm

Evening 7 8:30 pm

for individual/groups (to be updated)

Visa

_________________________________

____________________ Bank ________________________________

Other products available:

Interested to receive the electronic catalogue and information? Please select by tick into the box

Add-Venture Magazines Bi-weekly (Singapore Fun Maths)

Inspire Magazines Bi-weekly (Learning English grammars through stories)

Math Games Numbers (Singapore Maths Games)

Math Games Geometry (Singapore Maths Games)

Verdee products (Environmental-friendly Biodegradable Bamboo Products)

Thermomix (Germany) The Smallest Kitchen

Kitchen Gadgets & Kitchen Utensils (European Design)

Electrolux Kitchen Appliances