Ladies/Girls Hifz Enrolment Form

Daar Ibn Umar: Girls Fulltime Hifz

Application Form
Times:

Monday   7:00am - 2:00pm
Tuesday 7:00am - 2:00pm
Wednesday 7:00am - 2:00pm
Thursday   7:00am - 2:00pm
Friday   7:00am - 11:30am

Seperate Boys and Girls Classes
Please verify that you are human*
Student Information:
Student Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemale
Current School Grade*
Language Spoken at Home
Extent of Previous Qur'an Studies *
Previous Place of Learning (if any)
Fluency of Qur'an Reading *
Is the Applicant Registered for Homeschooling?
If so, which curriculum is being used?
Skwirk/Complete Education Australia/Other
Any Medical Conditions We Should Be Aware Of:
(Allergies/Illness/Medication/Etc.)
Parent/Guardian Information:

Required if student is under 18. Otherwise optional
Please Specify Your Relationship with the Applicant *
Please choose one
Father/Guardian 1*

First NameLast Name
Mother/Guardian 2*

First NameLast Name
Primary Contact No*
Secondary Contact No
Email*
example@example.com
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Emergency Contact Details: (other than above individuals))
Emergency Contact *

First NameLast Name
Emergency Phone No*
Relationship to student
Agreement and Waiver and Release

I hereby declare that I am the Legal Guardian of the above child/applicant. I hereby additionally consent to my child or ward, upon his/her admission to Minto Community Study Centre Inc./Daar Ibn Umar, for participation in all Minto Community Study Centre/Daar Ibn Umar activities. And hereby execute this AGREEMENT, WAIVER AND RELEASE on the Applicant's behalf and discharge any and all claims for damages for personal injury, death, or property damage, mental or emotional harm of any kind which he/she/they may have or may hereafter accrue to the Applicant as a result of participation in said activities, except as non-waivable by law. This release is intended to and shall discharge in advance Minto Community Study Centre Inc./Daar Ibn Umar (its officers, employees, volunteers and agents) free and harmless for any loss, liability, cost or expense incurred as a result of his/her death, injury or property damage that the Applicant may sustain while on any premises being used by Minto Community Study Centre Inc./Daar Ibn Umar while participating in programs and activities.

I HAVE CAREFULLY READ THIS AGREEMENT AND WAIVER, AND RELEASE AND FULLY
UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A LEGALLY BINDING AGREEMENT
AND A RELEASE OF LIABILITY, A LEGALLY BINDING CONTRACT BETWEEN MINTO COMMUNITY STUDY CENTRE INC./DAAR IBN UMAR AND ME AND THE APPLICANT. I AGREE TO IT OF MY FREE WILL.
ANY UNENFORCEABLE PROVISION IN THIS AGREEMENT SHALL BE SEVERABLE AND SHALL NOT AFFECT THE ENFORCEABILITY OF ALL OF THE AGREEMENT’S OTHER PROVISIONS.
I have Read, Understood and Agreed to all of the above*

I Agree
*Note: This application does not confirm a place for the applicant. Upon successful admission we will contact you via Email, Text or Letter to inform you when the applicant may start attending classes.
Should be Empty:

Daar Ibn Umar: Girls Fulltime Hifz

Parent/Guardian Information: