Maths Rally School

347 Bukit Batok Street 34 #01-268 (2^nd Storey) Singapore 650347  Tel.: 6569 5535

contact@mathsrally.com  /  www.mathsrally.com

Student Registration Form

Registration No.:

Student’s Particulars

Name

Birth date

Maths Results

(previous year)

Age

Address

                                                  Singapore (                        )

Birth Cert. No.

Gender *

             Male  /  Female

Email

Race

Name of School currently attending

Contact No.

Parent’s / Guardian’s Particulars

Mother  /  Guardian

Father / Guardian

Name

Occupation

Contact No.

Email

Student’s Medical Data

If your child has any health or medical condition that needs the teacher’s attention, please specify below

Contact Person in Emergency

Name

Relationship

 To Child

Address

Emergency No.

Declaration

Official Use

I, the undersigned, agree to allow my *child/ward to participate in the programme and I have read and understood the rules and regulations stated and agree to abide by them and shall not hold the school or its staff responsible for any unforeseen mishaps.

________________________________________________________  

Parent’s / Guardian’s  Name & Signature                        Date                       

Programme / Module

Official Receipt No.

Commencing

Remarks