Mr Khemistry X Chem Made Easy Registration Form
Eric Kua Education Centre Pte Ltd
The Classroom Pte Ltd
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Student's Full Name *
Student's School *
Student's Mobile Number *
Parent's/ Guardian's name *
Parent's/ Guardian's Mobile Number *
Parent's/ Guardian's Email (to send invoice & receipt) *
Relationship to student *
Course / Subject *
Please select the academic programme the student is currently in.
Class (Sec 3)
Please select the timing you wish to enroll in
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Class (Sec 4)
Please select the timing you wish to enroll in
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Mode of lesson
Please select your preferred mode of lesson
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Date of first lesson *
Other information
How did you find out about us?
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Name of referrer
You agree that we (Mr Khemistry and/or The Classroom) may collect, use, disclose and/or process your personal/parent’s/guardian’s data to send you/them invoices for monthly fees or information on our services via text and/or email. You may withdraw your consent for our use and/or disclosure of your personal/parent’s/guardian’s data to some or all of the above purposes by giving us 28 days’ written notice at If you have any other questions regarding the collection, use, disclosure, access and/or correction of your personal/parent’s/guardian’s data, you may read Mr Khemistry’s personal data protection notice and privacy statement at *
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