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* - Mandatory fields
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
Home address*
Relationship to Student* Please select relationship to studentMotherFatherSpouseGrandparentAuntyUncleSiblingsOther
I am the main contact for all future communications via phone, email and SMS, including tuition fees. YesNo
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):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning Morning classes available 9am to noon
Preference:
Afternoon/Evening Afternoon classes available 12pm to 8:30pm
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
Student Full Name
Class Day Please select DayMondayTuesdayWednesdayThursdayFridaySaturdaySunday
Class Time
Centre Please select centreAustralBankstownBlacktownChester HillHornsbyHurstvilleLiverpool
I consent for my child to leave the centre without a parent/guardian at the end of their class/during the pick up period YesNo
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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
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*
Please provide your local GPs details:
Full Name*
Address*
Please provide a copy of your child’s birth certificate.
Individual reference number (This is the number before your name)*
Do you suffer from any allergies/medical conditions?* Please select belowYesNo
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
Do you have any learning, speech and/or hearing difficulties?* Please select belowYesNo
If Parent/Guardian 1 and Parent/Guardian 2 cannot be contacted, please let us know who we should contact in the event of an emergency.
Emergency Contact 1
First Name*
Relationship to Student* Please select belowGrandparentAuntyUncleCousinSiblingOtherSpouse
Please let us know*
Emergency Contact 2
Relationship* Please select belowGrandparentAuntyUncleCousinSiblingOtherSpouse
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
Person/s who may pick up your child on a less frequent basis. Any person unfamiliar to our staff will be required to show identification and will not be allowed to collect your child without written and/or verbal permission from the parents/guardians.
Authorised Pick Up Person 1
Relationship* Please select belowGrandparentAuntyUncleSiblingsOther
Authorised Pick Up Person 2
I have read and agree to abide by the enrolment terms and conditions. Click here to view Terms & Conditions.
I declare to the best of my knowledge the information provided in the enrolment form is true and correct.
I understand that inaccurate, misleading or untrue statements or knowingly withholding information may result in the cancellation of this enrolment form, and further pecuniary and disciplinary action may be taken.
Date submitted*
