Registration form - Starlight Centre

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Child's name (based on NRIC) *

Gender *

Name of school *

If your child is studying in Pathlight, please indicate

Please indicate child's school grade *

If you indicate as others, please fill up his/her grade in the box below

If others

Transport required?

Please fill in the address below if you select "Yes."

Address *

Please provide your address if you need us to pick up and drop off your child.

Child's interest at home

This information will help us understand your child better including coming up with coping strategies and mechanism.

Number of Siblings *

Child's Date of Birth (DDMMYY) *

Any allergies we should be aware of?

Diagnosis

Any issues/feedback from school?

Is there is anything else that you we should know about your child?

Mother's name *

First

Last

Mother's Contact number

Mother's Email *

Father's name *

First

Last

Father's Contact number

Father's email *

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