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A Trip to Kusu Island Registration Form
  • This Form is for payment via PayNow. For credit card or debit card payments please click HERE to be directed to our Eventbrite page (additional fees apply). 
  • If you wish to make your payment via PayNow, please continue with this Form: 
Children Attending

Please select as appropriate:

The Participation Fee per child is $12

Parents are welcome to join. 

For children aged 10 or below, a parent/guardian is required to accompany the child: 

CHILD 1 (Personal Information)
Name of Child
Age
Food Allergiesif any
0 /
Medication or Medical Conditionsif any
0 /
CHILD 2 (Personal Information)
Name of Child
Age
Food Allergiesif any
0 /
Medication or Medical Conditionsif any
0 /
Parent/Guardian (Name & Contact Details)
Name of Parentor Guardian
Home Address
Mobile Number
Emergency Contact No.
Leave us a Message
Optional
0 /
Voluntary Contributions

Swamiji's Programme is made possible by the kind support of numerous individuals. We thank you for your interest in contributing towards the event. Please select your preferred amount: 

Please select your preferred amount

$20
$30
$50
Payment

Amount

Children: $12 x [field106] = $ [12*field106]

Voluntary Contribution: $ [field113+field120+field119] 


Total Amount due: [12 * field106 + field113 + field120 + field119]

Before you proceed with this Form: 
  • Please make your payment via PayNow, for the total amount stated in the section above. 
  • Use our UEN: S96SS0126E, and mention "Nov Retreat <<Your Name>>" 
  • Please note that registration is confirmed only upon payment.
  • After you have completed your payment, please provide your Payment Reference No (last 6 digits) below:
Payment Reference/Receipt No:
Privacy Clause

By providing your personal data (or those of your children or ward) to Amriteswari Society (the “Society”), whether in writing, by email or other electronic means, you consent to the Society’s collection, use and disclosure of your personal data for the purpose of your membership in the Society; your participation in the Society’s activities and programmes; and for the Society’s administrative purposes (collectively the “Purposes”). You further consent to the Society transferring your personal data to any third party engaged by the Society to assist the Society in carrying out the Purposes. The Society will at all times be primarily responsible for your personal data. The Society respects your personal data and will not use your personal data for any other purpose except the Purposes.You hereby grant consent to the Amriteswari Society to take and use yours (parents) and your child’s image in any format for purposes of display, publicity and advertisement by the Society and in its promotional materials and website.

However, if you do not wish to give any of the consents stated, please inform us in writing which of the consents you do not wish to provide and we will note it accordingly. Kindly write to us at amrita@amma.org.sg. Thank you. 

Disclosures & Comments

I have disclosed all relevant medical, psychological and special needs information about my child. I understand that my child will be taught by volunteers who are not trained professionals.I also understand that at no time will Amriteswari Society volunteers administer medicine or other treatment.. I am aware that registration cannot be adjusted to take into account any special needs and the child will not be accepted into the programme.I also understand that at no time will Amriteswari Society volunteers administer medicine or other treatment. In the event of an emergency or my child being unwell, I must urgently collect or make arrangements for the collection of my child as directed by the officials of the Event. I understand and acknowledge that I am fully aware of the content and nature of a Bala Kendra event and assume all the possible risks of the child’s participation in the Event. I hold harmless and agree to indemnify Amriteswari Society, its officials and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property, which the child may suffer in relation to or arising from the child’s participation in the Event. I have fully read, understood and agree to all of the above.


Please note that in the event of rain, the Event may be shifted indoors, to an alternate venue.


By clicking SUBMIT, I confirm the above and that I have read, understood and agree to the policies and procedures for the registration of my child in Amriteswari Society's Trip to Kusu Island with Swami Purnamritananda Puri.


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