Form

Safety Dectecting Service Community Scheme
Registration Form

* required information

Participant's Name*

Participant's Age*

Participant's Contact Number*

Participant's Email Address*

Residential Address

Please Enter Full Address*

Applicant's Name

Applicant's Contact Number

Applicant's Email address

If yes, please provide other service provider

Please select the installation location in order of priority:
(The final installation location will depend on the actual environment and circumstances)

Disclaimer of the Collection and Use of Personal Data

The Senior Citizen Home Safety Association (hereinafter referred to as "the Association") may use the personal data you provide in this form to contact you regarding your application, to provide you with more information about the Association’s services.

I have read and agree to the above terms.*

Receive the latest promotional and event information

I agree to receive promotional and event updates from the Association and have read and understood the Association’s Privacy Policy Statement

I disagree to receive promotional and event updates from the Association and have read and understood the Association’s Privacy Policy Statement

Safety Dectecting Service Community SchemeRegistration Form

* required information

Safety Dectecting Service Community Scheme
Registration Form