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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.

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 is schedules 6-months after the end of the 8th session which is compulsory.

This is a "pay as you wish" programme, with a minimum nominal fee of $50. This nominal fee offsets a small fraction of the cost that makes this programme possible and also seeks to instil a sense of commitment so that the slot will not be wasted.

This form is a registration of interest and further confirmation of acceptance will be sent via email with information on how to "pay as you wish".

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.

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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
This is for us to contact you for important information.

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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 (July-August 2024). Each weekly session is 2 hours long.

Will you be ready to commit to the duration of this programme?

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* 26. This is a "pay as you wish" programme, with a minimum nominal fee of $50. This nominal fee offsets a small fraction of the cost that makes this programme possible and also seeks to instil a sense of commitment so that the slot will not be wasted.

Information on how to "pay as you wish" will be sent to your email upon confirmation.

Will you be able to commit to a "pay as you wish" amount?

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* 27. 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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* 28. 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.

Prior to the start of the programme, participants are required to sign an indemnity form stating that should they experience the signs and symptoms of mental health conditions, they will be required to seek professional help.

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

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* 29. I declare that the information given by me in this form is true to the best of my knowledge and I have not withheld any relevant particulars. I have disclosed all the information required to be given in this form. I accept that if any of the information given by me in this form is in any way false, or incorrect, Happiness Initiative shall have the right to remove me from this programme, or take appropriate action without notice and without assigning any reason.

I declare that I am 18 and above as of completing this form.

Happiness Initiative will take all reasonably necessary actions to ensure that the Confidential Information remains strictly confidential and is not disclosed to or seen, used or obtained by any person or entity except the parties involved, including National Youth Council.

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

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