• Qur'an Madrasah Waiting List Form

  • Asalamu Alaykum and welcome to the CYC Qur'an Madrasah!

    The CYC Qur'an Madrasah provides structured classes for students of all levels to learn how to recite the book of Allah (SWT)! These classes run twice a week over the course of the school term, taught by experienced male and female teachers with an excellent curriculum.

    Please ensure that you put accurate details in this form. All announcements and communication will go to the Primary Parent/Guardian contact number. Student's names will appear on any certificates that they receive, so double-check for correct spelling.

    For any details or further information regarding the Qur'an Madrasah, contact the Madrasah Admin:
    Phone: 0406 008 080
    Email: madrasah@cycaswj.com.au

  • Primary Parent/Guardian Details

    This will be the primary contact and point of communication for all Madrasah updates.
  • Format: 0000000000.

  • Secondary Parent/Guardian Details

    These details will only be used as a backup emergency contact.
  • Format: 0000000000.

  • Student Details

    Please input the details for ONE student. Please double check the name and date of birth for each student, as this will be displayed on any awards/certificates they receive. To add more students, select 'Yes' for the last question on the page.
  • Gender*
  • Date of Birth*
     / /
  • What level is the student currently on?*
  • Does your child have any diagnosed medical condition?*
  • Please select all that apply:*
  • Does your child have any diagnosed OR suspected learning, behavioural, speech, hearing or developmental condition?*
  • Please select all that apply:*
  • Please select the level for Autism Spectrum Disorder*
  • Please select the level for Attention Deficit Hyperactivity Disorder*
  • What level of support does your child require in a classroom setting?*
  • Do you have any other children that you wish to register?*

  • Student 2 Details

    Please input the details for ONE student. Please double check the name and date of birth for each student, as this will be displayed on any awards/certificates they receive. To add more students, select 'Yes' for the last question on the page.
  • Gender*
  • Date of Birth*
     / /
  • What level is the student currently on?*
  • Does your child have any diagnosed medical condition?*
  • Please select all that apply:*
  • Does your child have any diagnosed OR suspected learning, behavioural, speech, hearing or developmental condition?*
  • Please select all that apply:*
  • Please select the level for Autism Spectrum Disorder*
  • Please select the level for Attention Deficit Hyperactivity Disorder*
  • What level of support does your child require in a classroom setting?*
  • Do you have any other children that you wish to register?*

  • Student 3 Details

    Please input the details for ONE student. Please double check the name and date of birth for each student, as this will be displayed on any awards/certificates they receive. To add more students, select 'Yes' for the last question on the page.
  • Gender*
  • Date of Birth*
     / /
  • What level is the student currently on?*
  • Does your child have any diagnosed medical condition?*
  • Please select all that apply:*
  • Does your child have any diagnosed OR suspected learning, behavioural, speech, hearing or developmental condition?*
  • Please select all that apply:*
  • Please select the level for Autism Spectrum Disorder*
  • Please select the level for Attention Deficit Hyperactivity Disorder*
  • What level of support does your child require in a classroom setting?*
  • Do you have any other children that you wish to register?*

  • Student 4 Details

    Please input the details for ONE student. Please double check the name and date of birth for each student, as this will be displayed on any awards/certificates they receive.
  • Gender*
  • Date of Birth*
     / /
  • What level is the student currently on?*
  • Does your child have any diagnosed medical condition?*
  • Please select all that apply:*
  • Does your child have any diagnosed OR suspected learning, behavioural, speech, hearing or developmental condition?*
  • Please select all that apply:*
  • Please select the level for Autism Spectrum Disorder*
  • Please select the level for Attention Deficit Hyperactivity Disorder*
  • What level of support does your child require in a classroom setting?*
  • Should be Empty: