Madrassah Registration Form
Please fill in the form below.
CHILD’S DETAILS
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
BOY / GIRL
*
Boy
Girl
ANY MEDICAL CONDITIONS?
ANY SPECIAL NEEDS OR LEARNING DIFFICULTIES?
PARENT GUARDIAN DETAILS
NAME
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CONTACT NUMBER /EMERGENCY CONTACT NUMBER
*
-
Area Code
Phone Number
E-mail
*
WHAT IS YOUR RELATIONSHIP TO THE CHILD
IS YOUR PREFERENCE WEEKDAYS OR WEEKENDS
Madrassah Weekdays
Madrassah Weekends
Hifdh Mornings
Hifdh Evenings
Type a question
Submit Form
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