Admission – Madrassa An-Noor for the Blind

SECTION A: LEARNER DETAILS

First Name / s

Middle Name / s

Surname

Age

Date of birth

Identity Number

Passport Number

Date of Issue

Date of Expiry

Gender

Marital Status

Religion

Country of Origin / Birth

Country of Residence

Preferred Language of Communication

Section B: Contact Information

Physical Address

Address Line 1

Address Line 2

Postal Code

Country

Postal Address

Address Line 1

Address Line 2

Postal Code

Country

Contact Numbers

Home Number

Mobile Number

WhatsApp Number

Email Address

Section D: Medical

Visual Impairement

If other, please give details

What is the nature or degree of Visual Impairment?

How did you lose your vision?

If due to trauma or illness, please give details

Are you a registered blind person?

If yes, please provide your registration number

Disabilities

Do you have any other disability besides visual impairment?

If other, please specify

Please provide any additional details that we should be aware of

Section E: Family

Parents / Guardians

Fathers / Guardians First Name

Fathers / Guardians Surname

Fathers / Guardians Occupation

Mothers / Guardians First Name

Mothers / Guardians Surname

Mothers / Guardians Occupation

Primary Contact

Please Indicate your Primary Contact Person

Primary Contact's WhatsApp Number

Emergency Contact

Telephone (Mobile)

Telephone (Other)

WhatsApp Number

Email Address

Relation

Section F: Fees and Declaration

Payment

Please Select a fee Option

If you are unable to pay the fee and would like to apply for a bursary, please request a Bursary application form.

If you are able to pay the full fee, please complete the Fees Declaration below

Fee Declaration

I hereby declare that I am able to pay the full monthly fee no later than the 1st of each month

Agreed Fee

Student Declaration

I hereby affirm that, to the best of my knowledge and beliefs, the information provided herein is accurate and truthful. I pledge to maintain a spirit of Islamic brotherhood, uphold good character, and treat my teachers, appointed officials, staff, and fellow students with kindness and respect. I commit to following the rules and regulations of the Madrassa and adhering to all directives. I will abstain from any behavior or practices that are contrary to Islamic principles and the values of the Madrassa. Furthermore, I acknowledge that I have read and understood the Madrassa's induction booklet and agree to comply with its contents.

Declaration by Parent / Guardian for a Minor

First Name

Surname

ID Number

I hereby affirm that, to the best of my knowledge and beliefs, the information provided herein is accurate and truthful.

Section G: Consent and Indemnity

Declaration

First Name

Surname

Physical Address

As the Parent / Guardian of

First Name

Surname

I hereby acknowledge the following regarding my child's/ward's attendance at Madrassa An-Noor for the Blind:

I understand that my child's/ward's participation at Madrassa An-Noor for the Blind is entirely at my own risk. Neither Madrassa An-Noor for the Blind, nor its officials, teachers, or staff, shall be held liable for any injury, loss, death, or damage that my child/ward may experience as a result of their attendance at the institution. I acknowledge that the officials, teachers, and staff will, however, take all reasonable precautions for my child's/ward's safety and well-being.

Date

Supporting Documentation

Please upload the following documentation

Passport / ID Photo

Maximum file size: 128 MB

Copy of Passport / ID

Maximum file size: 128 MB

Parent / Guardian's Passport / ID Photo

Maximum file size: 128 MB

Contact

Quick Links

Join Our Newsletter