Student Registration Form

Student's Name (as in Birth Cert / Identity Card / Passport)
*First Name: Middle Name: Last Name:

*Gender: Male Female *BC / NRIC / Passport No:

*Residential Status: S'pore Cit S'pore PR Dep Pass Stud Pass Others

*Date of Birth (day, month, year):
*Country of Birth:

School
Name: Address:
Postal Code: Tel No: Present Class in school:

2nd Language in school: Hindi Tamil Malay Mandarin None Others

Are Student's Results to be sent to his/her school? Yes No

Has Student studied Hindi? If 'Yes', please indicate:
*Highest Standard Passed: Name of Institution:
Place where Studied:

Any special medical conditions such as Bronchial Asthma, Diabetes Mellitus, Epilepsy, Drug or Food Allergies, etc?
If Yes, please specify:

Parent's / Guardian's Name
*Title:
*First Name: Middle Name: Last Name:

Residential Address
*Address 1:
Address 2: *Postal Code:

Contact Info
*Tel No: Handphone No: Pager No:
Email:

Occupation:

Parent's / Guardian's Residential Status: S'pore Cit S'pore PR Empl Pass

Do you have any other children studying at the Hindi Centres? Yes No