Madrassah Noorul Islam Application Form

Please note that we only accept student age 5 and above. We recommend to apply for your child when they are 4 years old as we do have a long waiting time.

Student Details

First Name(s)

Surname

Gender

Male Female

Date of Birth

Address

House Number

Street/Road

City/Town

Postcode

Home Phone

Father's Phone

Mother's Phone

Father/Mother/Guardian Email

Guardian's Name

Relationship to Student

Emergency Contact

Contact Name

Relationship to Student

Contact Number

Previous Islamic Education

Madrassah

Reason for Leaving

Quran Level

Qa'ida Naazarah Hifz

Other Relevent Information

Prefered Timing

16:30-18:00 18:15-19:45

Illnesses

Requirements

Allowed to go home alone

Yes No

Explain Going home option