Admission Form

MNB Admission Form

(A) PERSONAL DATA

First Name*

Middle Name

Last Name*

Date of Birth*

Age*

Identity Number*

Date of Issue*

Passport Number*

Expiry Date*

Gender*

Religion*

Nationality*

Preferred Language of communication

Home Language

Eye Condition

Please Select Eye Condition

Please Select Eye Condition
Blind
Partially Sighted

select

Please Select Your Impairment

Please Select Your Impairment
Temporary
Permanent

Are you a registered Blind Person

Are you a registered Blind Person?

Are you a registered Blind Person?
Yes
No

Blind Registration Number

Educational Qualifications:

(i) Religious

Last Madrassa attended

Last grade completed and year

(ii) Secular

Last School attended

Last grade completed and year

Address:

Residential Address

Postal Address

Contact Details:

Phone Number

Fax Number

Mobile Number*

Email*

(B) PARTICULARS OF PARENTS
Full Name(s):

Fathers Name

Mothers Name

Passport / Identity Number:

ID/Passport Father

ID/Passport Mother

Occupation:

Occupation Father

Occupation Mother

CONTACT IN CASE OF AN EMERGENCY
Relative / Friend (Next of Kin)

Emergency Contact Name #1

Emergency Contact Number #2

Relation #1

Emergency Contact Name #2

Emergency Contact Number #1

Relation #2

Application Fees

select

Select Fees Options

Select Fees Options
I am able to pay the full fee as stated above
I am unable to contribute towards the full fees and would like to request for a Bursary.

BUSARY APPLICATION
(i) STUDENT
I, hereby authorise the Principal of Madrassa An-Noor for the Blind to be my Shar’ee Wakeel and pay for Madrassa fees, books, audio aids, equipment, etc during my stay at the Madrassa.

Bursary Applicant

(ii) PARENT / GUARDIAN

I, hereby authorise the Principal of Madrassa An-Noor for the Blind to act as Shar’ee Wakeel on behalf of:

Parental Guardian Name

Full Name of Student Acted on behalf

(Insert the full names of the student) and pay for his/her Madrassa books, audio aids, equipment, etc. during his/her stay at the Madrassa.

(D) DECLARATION

(i) STUDENT I hereby certify that to the best of my knowledge and beliefs the information stated herein is true and correct. I promise sincerely that I will at all times stay with Islamic Brotherhood, good character and kindness with my teachers, officials, staff and fellow students. I will act according to the rules and regulations of the Madrassa and spend my time in Islamic educational activities. I undertake to refrain from all anti-Islamic ways, dressing, practices and all those acts which are inconsistent with the norms and values of the Madrassa. I also undertake to abide by the Induction Booklet of the Madrassa which I have read and understood.

(ii) PARENT / GUARDIAN

Declaration – Parental Guardian Name

Declaration – Full Name of Student Acted on behalf

I, the (Parent/Legal Guardian) of (Student Name) hereby warrant that the information given herein is true and correct. I acknowledge that the Induction Booklet which I have read and understood binds my child/ward.

(E) DECLARATION BY PARENT / GUARDIAN FOR A MINOR

I, declare that the information supplied in this application is true and correct and that full details have been furnished.

(F) CONSENT AND INDEMNITY

I, (Insert your full names and address below) of the Parent / Legal Guardian

Consent of Guardian Name

Consent of Guardian Address

(Insert name of child / ward)

Full Name of Child/Ward

I acknowledge that my child’s / ward’s attendance at Madrassa An-Noor for the Blind:

1) Shall be entirely at my own risk and neither Madrassa An-Noor for the Blind, its officials, teachers or staff shall be held liable in respect of any injury, loss, damage which my child / ward may suffer from or any other cause arising from my child’s / ward’s attendance at the above mentioned institution, bearing in mind that the officials, teachers and staff will nevertheless take all reasonable precautions for my child’s / ward’s safety and well being.

2) My legal guardian and I indemnify, jointly and severally, Madrassa An-Noor for the Blind, its officials, teachers or staff against any claims which may be made against them by any third party arising out of the death or bodily injury from any cause arising from my child’s / ward’s attendance at the above mentioned institute, bearing in mind that the officials, teachers and staff will nevertheless take all reasonable precautions for my child’s / ward’s safety and well being.

RECOMMENDATION: (For First Time Students Only)

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