𝐈𝐧𝐬𝐭𝐢𝐭𝐮𝐭𝐞 𝐨𝐟 𝐉𝐚𝐦𝐚𝐢𝐜𝐚 𝐄𝐚𝐬𝐭 𝐒𝐭𝐫𝐞𝐞𝐭 𝐉𝐮𝐧𝐢𝐨𝐫 𝐂𝐞𝐧𝐭𝐫𝐞

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After school Programme For Children (Ages 6 - 17 Years Only)

𝗡𝗕. For publicity of the Centres, performances done by students, photographs of students and their works may be published in the print, social and/or electronic media

𝐑𝐄𝐆𝐈𝐒𝐓𝐑𝐀𝐓𝐈𝐎𝐍 𝐅𝐎𝐑𝐌

PLEASE COMPLETE THE FOLLOWING FORM

SELECT ONE THAT IS APPLICABLE TO YOU

RETURNING STUDENT

NEW STUDENT

Clear selection

REGISTRATION DATE

YYYY

NAME (Surname/First Name/Middle Name) *

DATE OF BIRTH *

YYYY

AGE *

SEX *

HOME ADDRESS *

SCHOOL ATTENDING *

GRADE LEVEL *

PARENT/GUARDIAN INFORMATION

RELATIONSHIP TO CHILD *

Father

Mother

Other:

NAME *

ADDRESS *

HOME PHONE NUMBER

MOBILE PHONE NUMBER *

WORK PHONE NUMBER

EMAIL ADDRESS

PLACE OF WORK AND ADDRESS

EMERGENCY CONTACT

NAME *

WORK PHONE NUMBER

MOBILE PHONE NUMBER *

HOME PHONE NUMBER

RELATIONSHIP TO CHILD *

Mother

Father

Other:

DOCTOR'S CONTACT INFORMATION (Name/Address/Telephone Number)

PLEASE SELECT THE COURSES FOR WHICH YOU ARE REGISTERING YOUR CHILD. - Courses and the days they are offered.

Select only one course per day. (The time table is subject to change throughout the year).

Monday- Drumming & Dance .
Tuesday- Music & Personal Development .
Wednesday- Creative Needle-Craft & Puppetry & Sign Language .
Thursday- Drumming & Speech and Drama.
Friday- Creative Needle-Craft & Puppetry & Dance.

COURSES AND DAYS. (CHOOSE 1 PER DAY). (Scroll across at the bottom of this table to see additional courses).

Computer Skills

Art & Craft

Dance

Music

Drumming

Personal Development

Papermaking

Sign Language

English/ Reading

Speech and Drama

Creative Needle Craft and Puppetry

Monday

Tuesday

Wednesday

Thursday

Friday

Clear selection

COURSES AND DAY( CHOOSE 2). (Scroll across at the bottom of this table to see additional courses). *

Art & Craft

English/Reading (11 - 17 Year Old)

English/Reading (6 - 10 Year Old)

Speech & Drama

Dance

Personal Development

Computer Skills

SATURDAY

ADDITIONAL INFORMATION REQUIRED

NB.Your child will not be be discriminated against based on truthful information given.

Does your child have any illness/condition that would affect him/her participating in physical activities? If yes, please explain. *

Does your child have any allergies? If yes, please explain *

Has your child ever been referred to a Counselor/Psychologist? If yes, please explain *

Has your child done any form of assessment? If yes, please explain *

Does your child have any challenges that you would like the assistance of a Counselor? If yes, please explain *

If required would your child be available to participate in Junior Centre related activities/performing assignments on the weekends? If yes, select the day(s) on which he/she would be available. *

Yes

Saturday

Sunday

Required

Is your child allowed to be apart of research done at the Centres? (example completing short surveys/questionnaires). *

Yes

How did you find out about this programme? *

Friend/Family

Flyer

Radio/TV

School

Facebook

Instagram

You Tube

Website

Other:

Required

PICK-UP ARRANGEMENTS

My child will:- *

Name and phone number of person who will be picking up your child (If child won't be picked up indicate not applicable). *

NB: Please email a photo of applicant(child) within a week after applying to 𝐞𝐬𝐭@𝐣𝐮𝐧𝐢𝐨𝐫𝐜𝐞𝐧𝐭𝐫𝐞-𝐢𝐨𝐣.𝐨𝐫𝐠.𝐣𝐦.include " PHOTO (Name of Applicant)-ASP" in the subject line.

AGREEMENT WITH TERMS OF THE PROGRAMME AND COVID-19 PROTECTIVE MEASURES

PLEASE CLICK ON LINK TO VIEW AGREEMENT WITH TERMS OF THE PROGRAMME AND COVID-19 PROTECTIVE MEASURES AND CODE OF CONDUCT.

https://dochub.com/snrsecretary/Dbd3xkWVe2ydDBWw49AYlz/afterschool-code-of-conduct-march-2022-jc-pdf?dt=Sdr6MSVPAS31xSQq6sp7

Write your name if you have read the registration form and the Code of Conduct and will abide by the regulations of the programme contained therein. *

Submit

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