Application Form
Fields marked with an * are required

Section 1  - Details of Applicant

Gender *

Details of Parent/ Guardian (Under 18 Applicants only)

Section 2 - Details of any previous Islamic Education

Section 3 - Course Selection - Please tick as appropriate

Courses
Single Modular Courses - Delete as appropriate - Weekday/Weekend
Madrasah

Section 4 - Medical & Emergency Information

Emergency Contact 1 (Other than Parent/ Guardian)

I declare all information to be true and accurate & take responsibility for notifying the admin/principal of the organisation of any changes. I agree by signing this form to fully commit to the course times and dates and understand should I fail to comply with the organisations policies and procedures I may be suspended from the course. I also understand that should I wish to leave the course after two weeks of admission that no refund will be made and cost for the term will be incurred. In the event of an emergency I consent to receiving medical care and first aid by authorised first aid persons and will not hold the organisation liable in the event of any mishaps.