After School Haven Registration Form

Child's Information

Full Name

Date of Birth

Gender

Male Female

Home Address

Name of School

Class

Parent's / Guardian Information

Full Name

Relationship to Child

Phone Number

Alternative Phone Number

E-mail Address

Residential Address

Pick-up Authorization

Primary pick-up contact details (full name, relationship, phone number & a recent picture not more than 3 months old). N.B. If the primary pick-up isn't available, kindly notify the team at least 24 hours ahead with a written authorization of who will be doing the pick-up, with recent photos attached.

Full Name

Relationship

Phone Number

Recent Picture

Medicals

Does your child have any medical conditions / allergies?

Yes No

If yes, kindly state

Preferred Program Plan

What's your preferred option?

Full Option (Monday to Friday, pick-up, homework support, extra-curricular activities) Mini Option (Selected days & extra-curricular activities) Customized Option (Tailored to your preference, in alignment with our offerings)

Emergency Contact

Full Name

Phone Number

Relationship

Photography & Videography

I grant permission for my child to be photographed or videotaped during program activities. I understand that these images may be used for promotional purposes.

Release of Liability

The Program will take reasonable care in supervising children but will not be responsible for injuries or losses that occur without negligence on its part or due to circumstances beyond its control.

Yes No

Consent

I hereby grant permission for my child to participate in the After School Haven program. I understand that the program will provide a safe and supervised environment for my child to engage in academic, recreational, and social activities, and I confirm all information provided is accurate.

Yes No Maybe

Signature

I have read and understood the terms and conditions.

Reserve a spot

for your child/ward