Enrolment

Course Registration Form

Please Note we are closed on Fridays. Please DO NOT request meetings or classes on a FRIDAY.

Student's Details

Student's First Name(*)

Please type your full name.

Student's Surname(*)

Please type your full name.

Gender(*)

MaleFemale

Please specify your position in the company

Date of Birth(*)

/ / Invalid Input

Age(*)

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House number/Street(*)

House/Flat Number and Street

Town/City(*)

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Post/Zip Code(*)

Invalid Code

Country(*)

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Mobile Number(*)

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E-mail(*)

Invalid email address.

Parents/Gaurdians Details for students Under 18 years of age

First Name(*)

Please type your full name.

Surname(*)

Please type your full name.

Mobile Number(*)

Invalid Mobile

E-mail(*)

Invalid email address.

Select the Course(*)

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Is applicant currently studying with some one?(*)

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Whom is applicant studying with?(*)

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Applicant's level @ the subject(*)

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Why do you want to study with Al-Itqaan(*)

Mandatory Field

Preferred Days and Time (Example: Monday - 09:00)(*)

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Additional Information

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Is any one else from your household a student with us(*)

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Can you afford to pay?(*)

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Reasons for Free or subsidy(*)

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How much can you contribute?(*)

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Do you have a TV(*)

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Cost of TV Per Month(*)

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Cost of Tuition Per Month(*)

Invalid Input

Cost of Clubs/ Activities(*)

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(*)

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Course Registration Form

Asalaam alaikum

Jazakallah Khairun