Positioning for Success Workshop For Parents

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					501, Margaret Drive Singapore 149306 • Telephone 6475 2072•Fascimile 6473 9739 Email: rctc@rainbowcentre.org.sg
                                                                                                                                     Positioning for Success
                      Rainbow Centre Training & Consultancy

                                       REGISTRATION FORM
                                                                                                                                     Workshop For Parents
  Participants’ Particulars
  Name:                                                                                                           Mode of Payment
                                                                                                                   Cheque             Amt : ________________
  Nationality:                                                                                                    Bank & Cheque No : ______________________________
  Educational Level:                                                                                               Cash (for payment at Rainbow Centre Office, Level 2 Office.
                                                                                                                  Please do not send in cash via mail).
  Contact No (Handphone):
                                                                                                                  Cheques are to be made payable to :
  Address:                                                                                                        Rainbow Centre Training & Consultancy

  Residence Tel :

  Particulars of Child with Special Needs                                                                         For official use
  Name of Child:                        NRIC:                                         DOB:                        Received by             Payment of $ _____       Receipt No:
                                                                                                                  Date:                   Received
  Diagnosis :                                                                         Nationality:                                        Cash/Cheque              _____________

  School Currently Attending:
   RCMDSS                  RCYPS                 Nil
   Others: ____________________________________(please specify)

                                                                                                                  Note : Confirmation of participation is only upon receipt of payment
  For students of RCMDS / RCYPS, please indicate Programme:
                                                                                                                  together with Registration Form.
   EIPIC             PCMH             Early STEP              STEP