501, Margaret Drive Singapore 149306 • Telephone 6475 2072•Fascimile 6473 9739 Email: firstname.lastname@example.org
Positioning for Success
Rainbow Centre Training & Consultancy
Workshop For Parents
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:
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