Ribat Children's Hifẓ Programme

Ribat Children's Hifẓ Programme
Please note submission of this application does not guarantee a place on the programme. Applicants will be contacted by the Ribat admin team as soon as a place can be offered in sha Allah.
Students Name *

First Name Last Name
Gender *
Childs Date of Birth *

Day Month Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
Mobile Telephone Number *

Area Code Phone Number
Primary Email *

Confirmation Email

Parent / Guardian Contact Details

Please provide contact details for parents/guardians.
Fathers Name (or guardian) *

First Name Last Name
Fathers Email (or guardian) *
Fathers Mobile Number (or guardian) *

Area Code Phone Number
Mothers Name (or guardian) *

First Name Last Name
Mothers Mobile Number (or guardian) *

Area Code Phone Number
Mothers Email (or guardian) *

Payment Details
Payments will be collected by direct debit only. By filling in these details you confirm you agree to set up a direct debit with the Ribat Institute upon the commencement of the programme. Please note payments are collected by GoCardless and you will be emailed before the first payment is taken. The tuition fee is £30 per month, per student.
Bank Name *
eg Natwest Bank Woking
Sort Code *
eg for 60-24-20 please write 602420
Account Number *
eg 49415311
Name of Account Holder *

Further Information and Application Submission
Please provide us with further information on how fluent your child is in reading the Qur'an.
Please check all that apply for your child *

Fluent Qur'an reader Learning to read Qur'an on Qaidah Has memorised parts of the 30th Juz of Qur'an
Please give us any further information on your child's reading of the Qur'an including chapters memorised, if he/she has completed Qur'an etc.
Please inform us if your child has any medical conditions or special needs. Please give us full details including names of any medication taken. *
I consent to pictures or videos being taken of my child for Ribat promotional videos/posters and/or social media *

Yes No
I authorise the Ribat Institute to teach my child in the Children's Hifẓ Programme. I understand the demands of the programme and will support and assist my child in memorising and reviewing the Quran at home.

I give permission for my child to go on field trips as and when necessary. I release the Ribat Institute and individuals from liability in case of an accident during activities related to the Ribat Institute as long as normal safety procedures have been taken. I authorise all medical and/or hospital procedures may be performed or prescribed by the attending doctor and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.
Signed *

First Name Last Name
Date of Signature *

Month Day Year
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Ribat Children's Hifẓ Programme

Parent / Guardian Contact Details

Payment Details

Further Information and Application Submission