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Participant Registration Form

Well-Being Circles is back again, organised in partnership with National Youth Council.

The Well-Being Circles (WBC) is designed to promote well-being skills and to bring about positive well-being outcomes for individuals.

This programme is not intended to replace any mental health treatment. If you are experiencing mental health issues, please seek professional help.

WBC will last for 8 sessions across 2 months. Each session is 2 hours long.

There will also be a 9th session which will be scheduled 6-months after the end of the 8th session which is also compulsory.

This programme operates on a "pay-as-you-wish model", with a minimum commitment fee of $50. The fee is non-refundable.

This form is a registration of interest and further confirmation of acceptance will be sent via email.

By submitting this form, you agree that Happiness Initiative may collect, use and disclose your personal data, as provided in this form, for the purposes of the administration of your registration, including to contact you for follow-up processes, in accordance with the Personal Data Protection Act. All information collected will be shared with National Youth Council.

In this event, photographs and video recordings of participants may be taken by Happiness Initiative and supporting partners for publicity purposes. Feel free to inform the staff if you would not wish to be included in the photograph.

Please read through this consent form before completing this form.

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* 1. First Name (as per NRIC)

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* 2. Last Name (as per NRIC)

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* 3. Last 4 Characters of NRIC
(E.g. 167J)

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* 4. Sex

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* 5. Mobile Number
We will use this to add you to our Community Well-Being Circles WhatsApp Chat group, where important updates are shared. You may leave the group after the programme ends.

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* 6. Email Address
This is for us to contact you for important information.

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* 7. Year of Birth

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* 8. Residential Status

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* 9. Race

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* 10. What is your Civil Status?

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* 11. What is the highest level of education you have completed?

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* 12. For your highest level of education, which institution did you go to?

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* 13. Which of the following best describes your main work status over the last 6 months?

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* 14. What is your Designation?

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* 15. What is your field of work?

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* 16. What is your area of interest?

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* 17. Which area(s) of community service are you interested in?

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* 18. Which part of Singapore do you live in. We are asking this question to get an understanding of the reach of our programme across Singapore.

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* 19. What is your postal code?
(E.g. 188674)

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* 20. Name of Next of Kin
We will contact your Next of Kin in case of emergency.

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* 21. Next of Kin Relationship to you

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* 22. Contact Number of Next of Kin

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* 23. Why do you want to join this programme?
This response will be shared with your group leaders, so they can better facilitate the sessions.

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* 24. What do you hope to achieve out of the programme?
This response will be shared with your group leaders, so they can better facilitate the sessions.

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* 25. This programme will last for 8 sessions across 2 months. Each session is 2 hours long, from 10AM - 12PM, generally on Saturdays. The venue will be at:

*SCAPE
2 Orchard Link #05-03
Singapore 237978

The detailed dates for each wave are listed below. Please select which wave you wish to commit to.

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* 26. Do you have any existing medical condition, mental health condition, special needs, physical impairment or substance dependence (i.e. dependence on alcohol, drugs, etc, excluding prescription by a certified medical professional)?

(Note: Having mental health conditions or seeking treatment will not affect a person's suitability for the programme, if the conditions are appropriately managed.)

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* 27. The WBC is designed to promote well-being skills and to bring about positive well-being outcomes. This programme is not intended to replace any mental health treatment.

If you are currently undergoing mental health treatment, please discuss with your mental health professional if such a programme will benefit you before signing up.

Should participants experience the signs and symptoms of mental health conditions, they will be required to seek professional help.

Participants may be invited to discontinue from the programme should be deemed unfit at any point during this programme.

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* 28. WBC aspire to be as inclusive as possible, we would like to know if you belong to any of these groups below.

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* 29. How did you find out about Well-being Circles?

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* 30. I understand that photograph(s) or image(s) will be captured during the WBC programme. Happiness Initiative and National Youth Council, may use and publish such photographs and or video recordings in websites, social media channels and other communication channels.

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* 31. I consent to receive marketing materials on programmes and events from the National Youth Council (including Youth Corps Singapore and Outward Bound Singapore).

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* 32. Please do not resubmit the form should you decide to change any details, instead contact us at info@happinessinitiative.sg.

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* 33. Please read the following consent form.

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* 34. This programme operates on a pay-as-you-wish commitment fee model. This fee seeks to instil a sense of commitment so that the slot will not be wasted. The minimum commitment is $50, and it is not refundable.

If you are unable to commit to pay, you can write in to us and we will assess your suitability for a sponsorship on a case by case basis.

Should you be eligible for a sponsorship we will find a sponsor for you that will pay the fee for your admission into the programme.

Will you be able to commit to a pay the commitment fee?

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