CITC Student Registration Form 2019
By submitting this form, I agree to the terms and conditions stated at the end of this form.

The program is fully sponsored by Google, CDAC, EA, SINDA, MENDAKI and is made free-of-charge to participants.
Availability is on a first-come-first-serve basis for eligible participants. Participant eligibility will be determined by the respective Self-Help Groups (CDAC, EA, SINDA, MENDAKI). Please note that enrolment in CITC is only open to students from low-income families, and that your child's space in the program is not confirmed until his/her eligibility has been verified by your Self-Help Group, or by presenting proof of MOE FAS status when requested by the Organizer.

Only successful applicants will be notified. Please submit only ONE response per child.

Code in the Community Jan-Mar 2019
Name of Child *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
NRIC of child *
Your answer
Name of Parent/Guardian/NOK *
Your answer
Relationship to child *
Email *
Your answer
Phone number *
Your answer
Alternative phone number (optional)
Your answer
Postal Code *
Your answer
Self-Help Group *
Please indicate which Self-Help Group you are a beneficiary of. If you are currently on MOE FAS, but are not a beneficiary, please select the option that is most appropriate you.
MOE Financial Assistance Scheme (FAS) *
My child has participated in Code in the Community before. *
Terms and Conditions *
Required
1. Personal Data Notice (Use of photos and videos)
By attending the event, you consent to the use of your child/children's photograph, voice, likeness, and image in any broadcasts of this event and in subsequent productions drawn from video or audio recordings of this event. The photographs and recordings may be published or broadcasted in the official Organizers' publications and in publicity materials, including the Organizers websites and social media.

Organizers are released from any and all claims, demands, costs and liability that may arise from the use of these interviews, recordings, photographs, videotapes or films, and/or any reproductions of same in any form, as described above, arising out of being interviewed, recorded, photographed, videotaped or filmed.

The Organizers agree not to disclose any personal information found in this form to any third party without the prior written consent of the Parent/Guardian.

2. Transport Indemnity
Transport to and from the program locations is generally not provided. In the event that my child/children are conveyed between program locations, I understand that my child/children are conveyed between program locations at my own risk and not at the risk of the Organizers who are acting only in liaison role between the Transport Contractor and parents.

I agree that the Organizers shall not be liable or be responsible for any accident or personal injury sustained or suffered by my child/children or for any damage to my child’s personal belongings, however caused, whilst my child/children is being conveyed, or is waiting to be conveyed, to and/or from the Organizers.

I hereby release the Organizers from any and all claims, demands, costs, actions or causes of action on account of or arising from any of the foregoing matters, including such action that may be taken by the Organizers subsequent to any accident or incident which personal injury has occurred.

3. In Case of Emergency
In the event of emergency, I do hereby authorize the Organizers to arrange such medical attention for my child/children as may be reasonable and available in the circumstances and I undertake to pay all medical and hospital fees and incidental charges in respect of medical attention given to my child/children and to reimburse the Organizers for any such fees and charges and all incidental costs and expenses which may have been paid by the Organizers.

The Organizers will endeavour to contact the Parent/Guardian using the given Next-Of-Kin contact details in this form.

I have read all the Terms and Conditions above. *
Required
How old is your child *
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