Beneficiary Sign-up for (1) Health Education for Seniors (2) Savvy Seniors
Thank you for your interest in supporting our programmes. Together let us bring hope and change lives.
Sign in to Google to save your progress. Learn more
Your Full Name (as per NRIC) *
Your Contact Number *
Your Age *
Your Gender *
Language You Can Speak *
Required
Where are you from? Please select one. *
Which programme are you interested to participate in? *
Required
Who are you staying with? *
Would you prefer meeting online via Zoom or for volunteers to visit you at home? *
Required
What are your availability for volunteers to visit you? *
10am - 12pm
2pm - 4pm
4pm - 6pm
8pm - 10pm
Not available
Monday - Friday
Saturday
Sunday
Do you currently use a smartphone? *
Have you been vaccinated yet? (in preparation for face to face option, when feasible) *
Yes
No
Completed 2nd vaccine shot
HOPE worldwide Singapore is committed to handling your personal data with care and privacy under the Personal Data Protection Act (PDPA). I consent to the management of my personal data as stated in the Privacy Notice published on HOPE worldwide Singapore website. I also consent to the use of photos, interviews and recordings taken during events that I have attended for publicity purposes. *
Required
Thank you for expressing your interest in our programmes!
For further clarification please contact
Joyce Tan: 93803004 / joyce_tan@hopewwsea.org
Adrian Ng: 96281148 / adrian_ng@hopewwsea.org
Anne Tan: 97986335 / anne_tan@hopewwsea.org
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms