Mr Khemistry X Chem Made Easy Registration Form
Eric Kua Education Centre Pte Ltd
The Classroom Pte Ltd
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Particulars
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.
Required
Class (Sec 3)
Please select the timing you wish to enroll in
Clear selection
Class (Sec 4)
Please select the timing you wish to enroll in
Clear selection
Mode of lesson
Please select your preferred mode of lesson
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Date of first lesson *
MM
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DD
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YYYY
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 mrkhemistry@gmail.com. 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 https://mrkhemistry.com/privacy-policy/ *
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