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Choose Your Participation Type

General Public

Healthcare Professionals

Patients And Survivors

First Name (As per NRIC/FIN)*

Last Name (As per NRIC/FIN)*

Contact Number*

Email Address*

Password*

Password Confirm Password

Title*

Full Name (As per NRIC/FIN)*

Email Address*

Date Of Birth*

Mobile No.*

Should be 8 characters onwards

Office No. (Main / DID)

Should be 8 characters onwards

Country Of Residence*

Password*

Password Confirm Password

If you are a certified medical professional in Singapore, please select the following in the drop down list below and provide your registration number.

Professional Registration*

For Singapore delegates, please indicate if you are a CME/CNE/CPE applicant. If you are a foreigner, please choose "NA".

Certification No.

Organization Name*

Department*

Designation*

First Name (As per NRIC/FIN)*

Last Name (As per NRIC/FIN)*

Date Of Birth*

Gender*

Male

Female

This field is hidden when viewing the form

Age*

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Religion

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Which hospital/doctor did you get your treatment from?*

Which hospital/doctor did you get your treatment from?

*To support you better in our programme planning

Medical Condition / Type Of Cancer*

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Treatment(s)*

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Food Preference*

Are you a:*

Dietary Requirements*

Allergies/Special Needs*

Parent's First Name*

Parent's Last Name*

Contact Number*

Email Address*

Address*

Country Of Residence*

Postal Code / Zip Code*

Password*

Password Confirm Password

Other Remarks

Are you interested to join VIVA’s activities?*

Yes

No

CAPTCHA

I have read and agree to the terms and conditions.*

I have read and agree to the terms and conditions.*

I would like to receive news, information, updates from and about the VIVA Foundation for Children with Cancer.

I would like to receive news, information, updates from and about the VIVA Foundation for Children with Cancer.

General Public

VIVA General Programme & Event Registration

Step 1 of 5 - Participant Information

20%

Thank you for your interest in joining our upcoming activities!

Please complete the form below to register your participation.

1. Participant Information

Full Name(Required)

Preferred Name

Date of Birth(Required)

DD slash MM slash YYYY

Age(Required)

Please enter a number greater than or equal to 0.

Gender(Required)

Male

Female

Prefer not to say

Other

Please specify your gender(Required)

2. Number of Attendees

Children (Under 18)(Required)

Adults (18+)(Required)

Total Number Attending(Required)

Please enter a number greater than or equal to 1.

3. Contact Information

For participants under 18, please provide parent/guardian details.

Primary Contact Name(Required)

Relationship to Participant (if applicable)

Contact Number(Required)

Email Address(Required)

4. Emergency Contact

Emergency Contact Name(Required)

Relationship to Participant(Required)

Primary Phone Number(Required)

Alternative Phone Number

5. How Did You Hear About Us?

Please let us know how you learned about this event/programme:

How Did You Hear About Us?(Required)

VIVA Website / Newsletter

Social Media (Facebook, Instagram, LinkedIn, etc.)

Word of Mouth / Friend or Family Referral

Poster / Flyer

Partner Organization / School / Community Center

Other

Please specify how you heard about us(Required)

Additional Details

6. Dietary Requirements & Allergies

Dietary Preferences(Required)

No restrictions

Vegetarian

Vegan

Halal

Other

Please specify other dietary requirements(Required)

7. Event Terms & Participation Agreement

By registering, I/we understand that:

Participation in VIVA Life Programme activities is voluntary.
Participants are responsible for informing event organizers of any medical, accessibility, or dietary requirements.
Event availability is on a first-come, first-served basis where capacity is limited.
VIVA reserves the right to modify, postpone, or cancel activities due to unforeseen circumstances.

Do you agree to the terms above?(Required)

Yes

No

8. Photo & Media Consent

During events, photographs or video footage may be captured for community updates, reports, or promotional materials.

Photo & Media Consent

I CONSENT to media capture and use on official websites, social media, and printed materials.

10. Declaration

I confirm that the information provided in this form is accurate and complete.

Declaration(Required)

Yes

Healthcare Professionals

Education Programme Registration

Prefix

First Name(Required)

Last Name(Required)

Email Address(Required)

Country/Region(Required)

Organization(Required)

Job Title(Required)

Do You Require a Certificate of Attendance?(Required)

Only for healthcare professionals present for at least 75% of the duration of the webinar.

Yes

No

Professional Registration Number

Applicable to Singapore healthcare professionals for accreditation purposes (CME/CNE/CPE), subject to approval.

Are you a?(Required)

Physician

Pharmacist

Nurse

Researcher

Scientist

Surgeon

Oncologist

Other healthcare professional

What are your sub-specialties?

Are you in private or public practice?

Private

Public

Do you have another profession? What is it?

Age(Required)

21–34

35–44

45–54

55–64

65 and above

Would you like to join VIVA's Mailing List?(Required)

Yes

No

Questions & Comments

Patient and survivors

Step 1 of 5

20%

Thank you for your interest in participating in the VIVA Life Programme.

The VIVA Life Programme organises activities, events, and bonding opportunities for children and young people affected by cancer, including patients and survivors. These activities provide opportunities for friendship, confidence-building, enjoyment, and meaningful experiences beyond treatment.

Please complete this form to register your interest in participating in VIVA Life Programme activities and events.

1. Participant Information

Full Name(Required)

Preferred Name

Date of Birth(Required)

DD slash MM slash YYYY

Age(Required)

Please enter a number from 0 to 100.

Gender(Required)

Male

Female

Prefer not to say

Other

Please specify your gender(Required)

2. Number of Attendees

Please indicate the total number of people attending the event.

Number of Children(Required)

Number of Adults(Required)

Total Number Attending(Required)

Please enter a number greater than or equal to 1.

Please enter the total of children and adults listed above.

3. Parent / Guardian Information

To be completed by the parent/guardian.

Parent / Guardian Name(Required)

Relationship to Participant(Required)

Email Address(Required)

Contact Number

4. Emergency Contact

Emergency Contact Name(Required)

Relationship to Participant(Required)

Emergency Contact Number(Required)

Alternative Emergency Contact Number

5. Participant’s Cancer Journey

Current Status(Required)

Currently undergoing treatment

In remission

Completed treatment

Long-term survivor

Other

Please specify the participant's current status

6. Accessibility & Support

Assistance Required

No additional assistance required

Mobility assistance

Dietary assistance

Transportation assistance

Assistance with communication

Assistance with activities

Other

Please specify other assistance required

Please provide any additional information that may help our team support the participant

7. Dietary Requirements & Allergies

Dietary Requirements

No restrictions

Vegetarian

Halal

Other

Please specify other dietary requirements

Food Allergies / Intolerances

None

Yes

Please specify food allergies or intolerances(Required)

Other Allergies or Environmental Sensitivities

8. Consent & Participation

I/We understand that:

Participation in VIVA Life Programme activities is voluntary.
VIVA will make reasonable efforts to ensure that activities are conducted in a safe and appropriate manner.
Participants and/or their parent/guardian are responsible for informing VIVA of any relevant medical, physical, dietary, or accessibility requirements.
VIVA may contact the participant or parent/guardian regarding upcoming activities and events.
Participation in an activity may be subject to availability, suitability, and any applicable safety requirements.
VIVA reserves the right to modify, postpone, or cancel activities where necessary.

I/We have read and understood the above information and agree to the terms of participation(Required)

Yes

No

9. Photo & Video Consent

During VIVA activities and events, photographs and/or videos may be taken for documentation, programme reporting, fundraising, or communication purposes.

Please indicate your preference:(Required)

We consent to photographs/videos of the participant being taken and used by VIVA for programme-related purposes, including VIVA's website, social media, publications, and reports.

We do not consent to photographs/videos of the participant being used for these purposes.

10. Declaration

I/We confirm that the information provided in this registration form is accurate and complete to the best of my/our knowledge.

I/We understand that I/we should inform VIVA if there are any changes to the participant's medical, physical, dietary, or other relevant circumstances that may affect participation in VIVA Life Programme activities.

Is the information provided accurate and complete?(Required)

Yes

No

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