Registration Form Saadiqaat Registration Saadiqaat Step 1 of 7 14% 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 Cell: Permanent Address of Learner Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Person/s learner resides with: Both Parents Mother Father Other Tel: Cell: Allergies/Medical conditions of note:Doctor: Tel: Section B: Particulars of ParentsFathers InformationFather Married Divorced Remarried Separated Widowed Single Guardian Name: Surname: Other Names: ID/Passport No: Work Tel: Home Tel: Cell: Email: Occupation: Business Tel: Mothers InformationMother Married Divorced Remarried Separated Widowed Single Guardian Name: Surname: Other Names: ID/Passport No: Home Tel: Work Tel: Cell: Email: Occupation: Business Tel: Section C: 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 D: Academic ParticularsExtent of Islamic education: Extent of Secular education: Last Madrasah attended: Last Secular Institute attended: Is the applicant sufficiently fluent in his recitation of the Holy Quran? Yes No Section E: FeesAccount/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 F: IndemnityThe indemnity must be signed for acceptance of the application to the institution.Consent(Required) I agree to the privacy policy.I/We accept that Madrasatus Saadiqeen/Saadiqaat will take all reasonable precautions within their capacity for the safety and welfare of all the pupils while they are within the premises and boundary of the institute. I/We acknowledge that my child/ward attends the institute at my/our own risk. I/We as the Parents/Guardians indemnify and hold harmless the Madrasah, it’s staff, personnel and any parent or pupil against and from any, or all claims, whatsoever, that may arise in connection with any unforeseen loss of, or damage to, the property of my /our child/ward or injury to his/her person in the cause of duty, teaching or otherwise. This is also applicable to outings and transportation of learners to and from the premises of the Madrasah.Signature of Parent/s/GuardianDate DD slash MM slash YYYY Witness 2Witness 1 Section G: 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/Saadiqaat as brought to my notification through the pupil’s stay at the Madrasah. I agree to the principal of the institution using his discretion in all matters pertaining to my daughter or sister.Signature of Parent/guardianDate DD slash MM slash YYYY Signature of StudentDate DD slash MM slash YYYY
