Registration Form Adult Online Courses Online Class Registration Form Step 1 of 5 20% Section A: Particulars of learnerAdmission for : (state class) Date Rec: Adm No: Name: Surname: Other Names: Current Age: Date of Birth: DD slash MM slash YYYY ID/Passport No: Marital Status Single Married Divorced Zoom ID: Permanent Address of Learner Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Tel: Cell: Email Allergies/Medical conditions of note:Doctor: Tel: Section B: Particulars of next of kinName: Surname: Other Names: ID/Passport No: Home Tel: Work Tel: Cell: Email Relationship to Learner: Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Section C: Academic ParticularsExtent of Islamic education: Extent of Secular education: Is the applicant sufficiently fluent in his recitation of the Holy Quran? Yes No Section D: FeesFees for the year 2024 online classes are set at R 3 600.00 Per Annum.Account/Correspondence to be made to: Name: Surname: Home Tel: Work Tel: Cell: Email: If unable to pay or can only afford a reduced amount, kindly contact the principal. Confidentiality will, Insha Allah, be maintained Section E: DeclarationConsent(Required) I agree to the privacy policy.I, the undersigned, do hereby solemnly declare that all the information provided herein is correct and that I will abide to the full complement of rules of Madrasatus Saadiqeen as brought to my notification. I agree to the principal of the institution using his discretion in all matters pertaining to myself.Signature of Student (18 yrs. +)Date DD slash MM slash YYYY
