Parent Interest Form

Date*

Referred by

Parent’s Contact Details

Mother’s First Name*

Mother’s Family Name*

Mother’s Contact Number*

Mother’s Email Address*

Mother’s Occupation*

Mother’s Employer’s Name*

Father’s First Name*

Father’s Family Name*

Father’s Contact Number*

Father’s Email Address*

Father’s Occupation*

Father’s Employer’s Name*

Home Address*

Postal Code*

Child’s Information

Child’s First Name*

Child’s Family Name*

Chinese Characters (if applicable)

Birth Date (DD/MM/YYYY)*

Age*

Select Sex*MF

Name of Current School*

Current Level*

Consent to collection, use and disclosure of personal data:

By submitting the requested information through this website and/or form, I hereby agree and consent to the collection, use and disclosure of my personal data by Rosebrook Developmental Centre Pte Ltd (Rosebrook) and the sharing of my personal data with Rosebrook authorised service providers and relevant third parties for the purpose of communicating to me details about the various programmes, events, workshops and other activities of Rosebrook and other related purposes. I also agree to photographs being taken and/or images being captured at these activities, which may be used for publicity and/or training purposes in various media by Rosebrook.

Where I am providing such personal data on behalf of others, I confirm I have obtained the consent of these individuals for the disclosure of their personal data for the purpose stated above.