WBC Participant Registration Form

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.

Please read through the consent form on our website 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

Male

Female

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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

Singapore Citizen

Singapore Permanent Resident

Foreigner

Other (please specify)

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* 9. Race

Chinese

Malay

Indian

Eurasian

Other (please specify)

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* 10. What is your Civil Status?

Single

Married

Divorced

Living as a couple

Other (please specify)

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

No Formal Qualification/ Pre-Primary/ Primary

Secondary Education & Junior College

ITE

Polytechnic Diploma

Other Qualification

Bachelor's or Equivalent

Post Degree

Other (please specify)

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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?

Secondary Student

ITE Student

JC Student

Poly Student

National Service Full-Time

University Student

Full-Time Employment

Self-Employed

Unemployed

Retired

Other (please specify)

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* 14. What is your Designation?

Director

Executive

Manager

Other (please specify)

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* 15. What is your field of work?

Accounting / Auditing

Administration / Support

Advertising/ Marketing / Public Relations

Arts & Design

Banking / Finance / Insurance

Biotech & Pharmaceutical

Building & Estate Management

Community & Social Services

Construction

Customer Service

Education / Training

Engineering

Entertainment / Performance

Government & Policy

Healthcare

Homemaker

Hospitality

Human Resource / Organisation Development

Information Technology

Installation / Maintenance / Repair

Investigation

Legal

Manufacturing

Media and Communications

Personal Care & Service

Research and Analysis

Sales

Sports

Transport

Uniformed Services

Other (please specify)

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* 16. What is your area of interest?

Arts

Community Service

Current Affairs

Enterpreneurship

Environment

Gaming

Health and wellbeing

Heritage and Culture

Media

Personal development

Sports

Other (please specify)

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

Arts

Children

Digital

Education

Eldercare

Environment and Water

Families

Health

Heritage

Mental Health

Migrant Workers

Special Needs/ Disabilities

Sports

Youth

Other (please specify)

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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.

North East (E.g. Hougang, Punggol, Aljunied, Eunos, Paya Lebar, Serangoon, Kaki Bukit, Pasir Ris, Seng Kang, Tampines)

South East (E.g. MacPherson, Mountbatten, East Coast, Bedok, Changi, Simei, Siglap, Marine Parade, Braddell Heights, Joo Chiat, Kembangan, Chai Chee)

Central (E.g. Kebun Baru, Marymount, Potong Pasir, Radin Mas, Yio Chu Kang, Ang Mo Kio, Bishan, Toa Payoh, Jalan Besar, Whampoa, Tanjong Pagar, Buona Vista, Moulmein, Queenstown)

South West (E.g. Bukit Batok, Hong Kah, Pioneer, Yuhua, Chua Chu Kang, Bukit Gombak, Keat Hong, Jurong, Clementi, West Coast, Boon Lay, Nanyang, Telok Blangah)

North West (E.g. Bukit Panjang, Holland Village, Bukit Timah, Marsiling, Yew Tee, Nee Soon, Sembawang, Admiralty, Woodlands)

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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 (October-November 2024). Each weekly session is 2 hours long.

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

Yes

If No, but you are still interested in joining the programme, please let us know your considerations:

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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.)

If Yes, please specify what condition, and how are you managing this condition (e.g. seeking professional help, etc.)

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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.

I understand and agree to participate in the programme

I do not agree to participate in the 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 disadvantaged groups below.

Ethnic minorities

Migrants

People with disabilities

Individuals with Mental conditions

Other (please specify)

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* 29. 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.

I agree and give my consent

I do not agree and do not give my consent

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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).

Yes

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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.

I understand

I do not understand

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* 32. Please read the following consent form.

I understand and give my consent

I do not understand and do not give my consent

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* 33. 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.

If you are unable to commit to pay, you will be required to 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 as you wish" amount?

Yes

If No, but you are still interested in joining the programme, please let us know your considerations.

WBC Participant Registration Form

Participant Registration Form

Question Title

* 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 NumberThis is for us to contact you for important information.

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* 6. Email AddressThis 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 (October-November 2024). Each weekly session is 2 hours long.Will you be ready to commit to the duration of 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 disadvantaged groups below.

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* 29. 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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* 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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* 32. Please read the following consent form.

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

* 5. Mobile Number
This is for us to contact you for important information.

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

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

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

* 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.

* 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.

* 25. This programme will last for 8 sessions across 2 months (October-November 2024). Each weekly session is 2 hours long.

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