Please email the completed form to: jjcpsgsam@gmail.com
JJC PSG Member Registration Form
Enrollment date (official use): ___________ Membership Number (official use): _______
Personal Information
Name: _______________________________________________
Contact Number: ______________________
Alternate Number (optional): _____________________________
Birthdate - Month/Day (optional): _________________________
Email Address: _________________________________________
Child Name: ___________________________________Gender: __________ Class: __________
Personal Interest (You may tick more than one):
Workshop ____ Seminar ____ Interaction Session: ____
School Activities: ____ Volunteer work: ____ Others: ____
Personal Preference
Meeting day: _____________________ Frequency: _________
Concerns For Your Child (You may tick more than one):
Academic Subjects ____ BG Relationship ____ Time Management ____
Gaming ____ Electronic Usage ____ Moral Values ____ Attitude ____
Others (please specific): __________________________________________________________
Signature: ___________________________ Date: ____________
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