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  About Masthead  
     
 
  To read more about the Beginning Experience family in other parts of the world
www.beginningexperience.org
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  Join us for a Weekend away for a Lifetime of Change.
Download the PDF Form or fill in the form fields below:
   
 
   
Beginning Experience¬ģ Weekend
     
Title  
     
* Name  
     
Address  
     
Country  
     
Postal Code  
     
* Contact Number (HP)  
     
Contact Number (Home)  
     
* Email Address  
     
NRIC  
     
Nationality  
     
Date of Birth  
     
Gender  
     
Occupation  
     
Highest Qualification  
     
Religion  
     
Parish (if applicable)  
     
Accomodation  
    * 1st come 1st serve basis
     
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For how long have you
been married?
  Years
     
For how long have you been divorced/separated/widowed?   Years
     
Line
     
Was this your first marriage?  
     
(If NO, please give details of the length of any other marriages and how they ended)  
     
Do you have children?  
     
(If YES, how many, and what ages?)   (Number)
    (Ages)
     
Are you currently involved in a steady relationship?  
     
(If YES, please state length of time)   (Months / Years)
     

Are you currently on
prescribed medication?

 
     
(If YES, please provide details of medical condition)  
     
Are you currently involved in
any kind of professional counselling or therapy?
 
     
(If YES, please provide details of professional counselling/therapy involved in)  
     
Do you have any physical/medical conditions, special dietary requirements or other special needs that we, as organisers of a live-in Weekend, should be aware of
(eg. do you need medication at set times?, Vision/Hearing Impairments. etc)
 
     
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How did you hear about the Beginning Experience?  
     
Others (please specify)  
     
Please comment on why you are interested in taking part in a Beginning Experience Weekend:  
     
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The Beginning Experience Weekend is a 2-night stay-in weekend which involves communal living. To fully benefit from the Weekend, you are required to actively participate in the Weekend.

DECLARATION & UNDERTAKING

I, the undersigned, hereby agree to attend the BEGINNING EXPERIENCE WEEKEND, a 2-night stay-in weekend organised by Beginning Experience (BE) Singapore. I shall abide by the House Rules during the Weekend, and agree to stay on the premises where the Weekend is conducted at all times.

I hereby affirm that I have full consent of the person(s) listed as my emergency contact person to be contacted in case of an emergency.

I shall not hold BE, its leaders or volunteers responsible or in any way liable for any death, injury, disability, loss or damage, arising in connection with the Weekend and my participation therein.

 
*
     
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In Case of Emergency:    
Next-of-kin Name  
     
Next-of-kin Contact nos.  
     
Relationship to the next-of-kin