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Registration Form - Intermark
Registration Form - Avenue K
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Use tab to navigate through the menu items.
Please fill in the form carefully for registration
Avenue K Registration Form
Student Information
First name
*
Last name
Date of Birth
*
Day
Month
Year
Gender
*
Male
Female
Address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Registration Type
*
Preferred Start Date
*
Payment Option
*
Cash
Debit or Credit Card
Bank Transfer
Parent 1 Information
First Name
*
Last Name
*
Email
*
Phone
*
Occupation
*
Address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Parent 2 Information
First Name
Last Name
Email
Phone
Occupation
Address
Country/Region
Address
City
Zip / Postal code
Identification Documents
Student Identification – Passport/IC
*
Upload File
Parent 1 Identification – Passport/IC
*
Upload File
Parent 2 Identification – Passport/IC
Upload File
Emergency Contact Information
First Name
*
Last Name
*
Phone
*
Relation to the Student
*
Emergency Contact Identification – Passport/IC
*
Upload File
Pediatrician's First Name
*
Pediatrician's Last Name
*
Medical Centre's Address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Student's Vaccination Record
Upload File
Does the Student have any Allergies?
*
Yes
No
If yes, please state
Does the Student have any Special Dietary Requirements?
*
Yes
No
If yes, please state
Parental Consent
Perosonal information
*
I allow Primrose Hill to hold personal information on their system.
I DO NOT allow Primrose Hill to hold personal information on their system.
Photos for Marketing Purposes
*
I allow Primrose Hill to use my child's photos for marketing purposes.
I DO NOT allow Primrose Hill to use my child's photos for marketing purposes.
Photos for In-House Purposes
*
I allow Primrose Hill to use my child's photos for in-house purposes.
I DO NOT allow Primrose Hill to use my child's photos for in-house purposes.
First Aid
*
I allow designated staff members of Primrose Hill to administer First Aid on my child.
I DO NOT allow designated staff members of Primrose Hill to administer First Aid on my child.
Supervised Activities
*
I allow my child take part in supervised activities within Avenue K Mall.
I DO NOT allow my child take part in supervised activities within Avenue K Mall.
Health Information
*
I allow Primrose Hill to share my child's health information with other health professionals.
I DO NOT allow Primrose Hill to share my child's health information with other health professionals.
Use of Paracetamol
*
I allow designated staff members of Primrose Hill to provide my child with paracetamol if their temperature is over 38.5c
I DO NOT allow designated staff members of Primrose Hill to provide my child with paracetamol if their temperature is over 38.5c
Last but not least...
Terms & Conditions
*
I agree to the Terms & Conditions [2026/2027] and have read and understood the Payment Policy [2026/2027].
Submit
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