CITC Registration Form 2018
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.

Only successful applicants will be notified.

Code in the Community Jul-Sep 2018
Name of Child *
Your answer
Gender *
Date of Birth *
Your answer
Name of Parent/Guardian/NOK *
Your answer
Relationship to NOK *
Email *
Your answer
Phone number *
Your answer
Alternative Phone number (optional)
Your answer
Postal Code *
Your answer
Age Group *
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) *
Is your child on MOE Financial Assistance Scheme (FAS) in 2018?
Terms and Conditions *
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
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.

Press "Next" to select your timeslot and location
Never submit passwords through Google Forms.
This form was created inside of 21C Girls. Report Abuse - Terms of Service