Home | SHINE Children and Youth Services

General Enquiry Form

Please complete all required fields and sections.

Select for which purpose you want to enquire:

Enquiry Details

I would like to enquire/receive support for…

Please fill in the details of the child/youth requiring our services (yourself or someone known to you)

Name as per NRIC

Preferred Name

Last 4 Characters of the NRIC

Biological Sex

Date of birth

Block / Unit Number

Street

Building Name

Postal Code

Country

Email Address

Mobile Phone

Alternative Contact Number

Parent/Guardian's Name

Parent/Guardian's Contact Number

Parent/Guardian's Preferred Language

Parent/Guardian's Email

Will there be an accompanying adult at the first session?

I am making this enquiry for

Consent

I acknowledge that I have read and understood SHINE’s Data Protection Notice (also available on our website www.shine.org.sg), and consent to the collection, use and disclosure of my personal data by SHINE Children and Youth Services for the purposes set out in the Notice.

I consent to the collection and use of my and/or my family member’s photographs and other audio-visual information.

If you are assisting to refer a child/youth, please let us know how to contact you and continue to fill the following where relevant/as best as able.

Name of Person who Enquired

Relationship to Contact

Contact Number of Enquirer

Email Address of Enquirer

Has the child/youth you are referring consented to the referral?

Are you willing to be contacted for further questions?

Do you require an update?

General Enquiry Form

Select for which purpose you want to enquire:

Errors:

Enquiry Details

Please fill in the details of the child/youth requiring our services (yourself or someone known to you)

Consent

If you are assisting to refer a child/youth, please let us know how to contact you and continue to fill the following where relevant/as best as able.

Consent