Please note: Submitting this form gives us your consent that you and your learner agree to all rules and regulations.
Full name
Date of bith
ID no.
Physical address
Home telephone
Mobile
Learner personal status
Home language
If guardian, state relationship to learner
Fathers name
Marital status
Address
Work telephone
Email
Employer
Occupation
Mothers name
Relationship to learner
Work
House
5.1 Medical history
Give a description of medical challenges of learner (if any)
Give a details of medication of learner (if any)
Give a details of allergies (if any)
5.2 Education history
Highest grade passed
Grade GradeGrade 0Grade RGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12
Year
School
Islamic courses passed during the past 3 years
Name of Islamic Institutions attended during the past 3 years
Give details of any learning challenges
I the undersigned hereby confirm that I will be responsible fo the payment of school and extra-mural activities.
The payment method of school fees shall be confirmed with the administrator of Dar Ahlil Quran (DARAQ). We the undersigned parents/ guardians of learner hereby confirm that we have acquainted ourselves with the rules and regulations of Dar Ahlil Quran (DARAQ) and we accept it.
Registration/ Admin fee: R350.00
1 + 3 = ? Please prove that you are human by solving the equation *