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First name
Surname
Date of birth
Gender MaleFemale
Centre AustralBankstownBlacktownChester HillHornsbyHurstvilleLakembaLiverpool
Language predominately spoken at home: EnglishArabicOther
Please enter other language
Enquiry from PhoneEmailF2FOther
Do you suffer from any allergies/medical conditions? YesNo
Please let us know from the selection below: DiabetesAnaphylaxisAsthmaEpilepsyAllergiesOther
Does the allergy or medical condition require an action plan? NoYes
Please provide ASCIA action plan
Please let us know
Do you take any prescribed medication? YesNo
What medication/s have you been prescribed?
Contact number
Email
Home address
Name of parent/carer
Program Selection Adults Bridging Early Learners Foundation Intermediate Quran Recitation and Memorisation Senior Studies
Adult Program Selection Tajweed: 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 Makkah (3 days a week): Monday – Wednesday, 9:30am – 1:30pmMadinah (2 days a week)Aqsa (1 day a week):
Madinah Date & Times Monday 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 EnglishArabic
Do you require child minding? Subject to availability. YesNo
Availability Tuesday afternoon/evening only
Do you have any children that attend Alfirdaus College? YesNo
Full Name
Class Day MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Class Time
Centre AustralBankstownBlacktownChester HillHornsbyHurstvilleLiverpool
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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? YesNo
Please provide an action management plan from your local GP for your child’s medication.
Does your child take any prescribed medication? YesNo
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? YesNo
Please provide details
Please provide your local GPs details:
Address
Please provide a copy of your child’s birth certificate.
Emergency Contact 1
First Name
Relationship to Student SpouseGrandparentAuntyUncleSiblingsOther
Emergency Contact 2
Relationship SpouseGrandparentAuntyUncleSiblingsOther
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? YesNo
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 GrandparentAuntyUncleSiblingsOther
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
