Parent's Name

Parent’s mobile number:

Parent’s email:

Child's Name:

Child’s Date of Birth:

Last 3 digits of IC PLUS alphabet:

Address:

Message:

Please insert video or insert YouTube link, here:

I consent to the collection, use and disclosure of my personal information and the personal information of my child by MindChamps Holdings Pte Limited, its related corporations and the franchisees of its related corporations (individually and collectively the “MindChamps Group”) for the purposes of (a) processing and responding to my enquiries; (b) providing services and sending you information on special events, promotions, offers and other marketing and promotional material; and (c) such other purposes as set out in section 2 of MindChamps’ Privacy Policy, in accordance with the Personal Data Protection Act 2012 and MindChamps’ Privacy Policy.

I acknowledge that I have read and consent to the above and you may contact me via my email account, telephone, SMS and/or other phone number-based messaging at the details provided in this form.