Student Enrolment Form

First name*

Surname*

Date of birth*

Gender*
Please select your genderMaleFemale

Contact number*

Email*

Centre*
Please select your centreAustralBankstownBlacktownChester HillHornsbyHurstvilleLakembaLiverpool

Language predominately spoken at home:*
Please selectEnglishArabicOther

Please enter other language*

Enquiry from*
Please selectPhoneEmailF2FOther

I consent to photos, videos and voice recordings to be taken and used for promotional purposes by Alfirdaus College.*
YesNo

Program Selection
Adults Bridging Early Learners Foundation Intermediate Quran Recitation and Memorisation Senior Studies

Adult Program Selection
Please select belowTajweed: Recitation of the Quran with the application of the correct recitation principlesTelaweeh: Fluent reading and reflection on the Quran and its meaningQuran Memorisation: Individual Quran memorisation programQaedah Al Noorania: Introduction to Quranic reading and recitation principles

Early Learners Date & Time*
Please select from belowMakkah (4 days a week): Monday – Thursday, 9:30am – 1:30pmMadinah (2 days a week)Aqsa+ (4 hours, 1 day - Available Monday to Thursday morning only)Aqsa (3 hours, 1 day - Available Monday to Sunday)

Madinah Date & Times*
Please select belowMonday and Tuesday, 9:30am – 1:30pmWednesday and Thursday, 9:30am – 1:30pm

Preferred class day and time in order of your preference (1-3):

Preferred class day and time in order of your preference (1-3):

Preferred course language*
Please select belowEnglishArabic

Do you require child minding? Subject to availability.*
Please select belowYesNo

Availability*
Tuesday afternoon/evening only

Do you have any children that attend Alfirdaus College?
Please select belowYesNo

Medicare number*

Individual reference number (This is the number before the name of the Student)*

Expiry date*

Does your child suffer from any allergies/medical conditions?*
Please select belowYesNo

Please let us know from the selection below:*
DiabetesAnaphylaxisAsthmaEpilepsyAllergiesOther

Please provide an action management plan from your local GP for your child’s medication.

Please let us know
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Does your child take any prescribed medication?*
Please select belowYesNo

What medication/s have you been prescribed?*

Please provide a medication administration plan from your local GP for your child’s medication.

Does your child have any learning, speech and/or hearing difficulties?*
Please select belowYesNo

Please provide details*

Full Name*

Address*

Contact number*

Please provide a copy of your child’s birth certificate.

Medicare number*

Individual reference number (This is the number before your name)*

Expiry date*

Do you suffer from any allergies/medical conditions?*
Please select belowYesNo

Please let us know from the selection below:*
DiabetesAnaphylaxisAsthmaEpilepsyAllergiesOther

Please let us know the details of your allergy/medical condition*

Does the allergy or medical condition require an action plan?*
NoYes

Please provide ASCIA action plan

Do you take any prescribed medication?*
Please select belowYesNo

What medication/s have you been prescribed?*

Do you have any learning, speech and/or hearing difficulties?*
Please select belowYesNo

Please provide details*

First Name*

Surname*

Contact number*

Relationship to Student*
Please select belowGrandparentAuntyUncleCousinSiblingSpouseOther

Please let us know*

First Name*

Surname*

Contact number*

Relationship*
Please select belowGrandparentAuntyUncleCousinSiblingSpouseOther

Please let us know*

If our staff are unable to reach your emergency contacts, do you give permission for staff to administer medication, emergency treatment and/or contact the appropriate authorities?*
Please select belowYesNo

First Name*

Surname*

Contact number*

Relationship*
Please select belowGrandparentAuntyUncleSiblingsOther

Please let us know*

First Name*

Surname*

Contact number*

Relationship*
Please select belowGrandparentAuntyUncleSiblingsOther

Please let us know*