PERSONAL DETAILSFull Name:(Required)Date of Birth(Required) DD slash MM slash YYYY Age(Required)Please enter a number greater than or equal to 1.Gender(Required) Male Female Occupation (if applicable):School (if Secondary Student):Academic Level:CONTACT INFORMATIONHome Address(Required) Street Address Mobile Number(Required)Alternative Contact Number(Required)Email Address(Required) Parent/Guardian Name:for students under 18 years oldMobile Numberfor students under 18 years oldAlternative Contact Numberfor students under 18 years oldEmail Address for students under 18 years oldCOURSE INFORMATIONPreferred Method of Attendance(Required) Onsite Offline QURAN LITERACY(Required) I’m an expert I can read but not fluently I can read but not with Tajweed I am still learning I don’t know how to read Quran EMERGENCY CONTACTName:(Required)Relationship:(Required)Mobile Number(Required)Alternative Contact Number:(Required)Email Address(Required) MEDICAL INFORMATIONDo you have any medical condition or allergy the Academy should be aware of?(Required) No Yes (Please Specify) Specify Here(Required)DECLARATIONI certify that the information provided in this registration form is true and accurate. I agree to abide by the rules, policies, and code of conduct of An Nur Islamic Academy throughout the duration of the course.Student Signature:(Required)Parent/Guardian Signature (if under 18):(Required)Current Date(Required) DD dash MM dash YYYY
