Apply | Madrasah Nasihah

Child's Details

First Name *

Middle Name

Last Name *

Gender *

Street Address *

City *

Post Code *

Age *

Date of Birth *

Name of Current School

Street Address

City

Postal Code

Country

Parent 1 Details

Relationship to child *

Are you the primary contact? *

First Name *

Last Name *

Email Address *

Mobile Number *

Home Number

Street Address *

City *

Postal Code *

Country

Parent 2 Details

Relationship to child *

Are you the primary contact? *

First Name *

Last Name *

Email Address *

Mobile Number *

Home Number

Street Address *

City *

Postal Code *

Country

Emergency Contact

This MUST be someone other than both parents.

Relationship to child *

First Name *

Last Name *

Email Address *

Mobile Number *

Home Number

Street Address *

City *

Postal Code *

Medical Information

GP or Surgery's Name *

Street Address *

City *

Postal Code *

Doctor's Phone Number *

Does the applicant suffer from any serious illnesses? E.g. Asthma, Epilepsy etc. (If yes, please give details) *YesNo

Medical Details

Previous Madrasah Details

Name of Madrasah

Street Address

City

Postal Code

Country

Phone Number

Apply Online

Child's Details