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Child’s Name

(as in Birth Certificate/ Passport)

Birth Cert/ Passport / UIN / Fin No
Date of Birth (DD/MM/YYYY)
Parent’s Name
Handphone Number
Annual Household Income
Intended Start Month(DD/MM/YYYY)
Programme Type ( Full Day / Half Day)
Class Age Please Select
Playgroup 18 months to 2 years old  / 
Nursery 1 The year they turn 3 years old  / 
Nursery 2 The year they turn 4 years old  / 
Kindergarten 1 The year they turn 5 years old  / 
Kindergarten 2 The year they turn 6 years old  / 
Short Survey
What is your current childcare arrangement?     Please tick (√ )
In kindergarten
In other childcare centre
Look after by babysitter
Look after by domestic helper
Look after by grandparents
Others (please specify)
Is your child presenting any of these issues? Please Select
Social Emotional  / 
Speech & Language  / 
Behavioural / Self-Control  / 
Learning (Academic)  / 
Multiple Issues  / 
Motor Skills  / 
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