MIFTAAHU AN-NAJAH MADRASAH REGISTRATION FORM

MIFTAAHU AN-NAJAH MADRASAH REGISTRATION FORM

Please complete all sections carefully
بِسْمِ اللَّهِ الرَّحْمَنِ الرَّحِيمِ MADRASATU MIFTAAHU AN-NAJAH, Shangisha Magodo, Lagos State. Nigeria

🛡️📖 A Citadel of Qur’ān & Sunnah — Raising Creative, Righteous Leaders. 🌟🎓
🧒 SECTION 1: STUDENT INFORMATION

Please fill in details as they appear on official documents.
Full Name (As on Birth Certificate)
Example placeholder: “Abdullah Sulaiman Adedayo”
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Place of Birth
Nationality
Country
Local Government Area (LGA)
Home Address
Previous School Attended (If any)
Example: “Darul-Huda Islamic Academy”
Class LastAttended
Example: “JSS 1 / Ibtidaiyyah 2”
Class Applying For
Passport Photograph

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State of Origin
SECTION 2 — GUARDIAN / PARENTINFORMATION

Please provide accurate parent or guardian details for communication and student welfare.
All information is confidential and used for admission, safety and communications only.
1. Guardian’s Full Name
2. Relationship to Student
3. Primary Phone Number*

Area CodePhone Number
4. Email Address*
example@example.com
5. Occupation
CivilServant / Trader / Imam
6. Home Address
Preferred Communication Method

WhatsAppSMSEmailPhone Call

🩺 SECTION 3: EMERGENCY & MEDICAL INFORMATION

Please provide accurate medical and emergency contact details. This information is confidential and used only for the safety and care of the student.
Emergency Contact Full Name
Emergency Contact Relationship
Emergency ContactPhone Number

Area CodePhone Number
Hospital Name
Hospital's Address
ANY MEDICAL CONDITION

YesNo
IF YES PLEASE LIST MEDICAL CONDITIONS AND INSTRUCTIONS:
e.g. Asthma — inhaler: Salbutamol 2 puffs as needed; epilepsy — medicine & emergency protocol.
Any known allergies?

YesNo
Specify allergy and typical reaction
e.g. Peanuts — anaphylaxis (hives, difficulty breathing).
Medical Report / Prescription Upload (if applicable)

Upload relevant health reports if student has a chronic condition or ongoing treatment.
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📚 SECTION 4: PROGRAMME(S) & FEES

Select programme(s) applying for. Fees are calculated automatically based on selections and payment plan. Scholarship applicants (P.Q.M) are assessed manually.
Select Programme(s)
📁 SECTION 5: REQUIRED DOCUMENTS (UPLOAD)

Please upload scanned copies or clear photos of the documents below. If you cannot upload now, you may bring originals to the admissions office.
Birth certificate

If you do not have a birth certificate, please upload ONE acceptable alternative (immunisation card, last school report with DOB, hospital birth notification, or a sworn affidavit). Originals must be shown at the Madrasah office within 14 days of admission.
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✍️ SECTION 6: CONSENT & DECLARATION

Read carefully, sign, and submit.
Photo & Media Consent:I consent to the use of my child’s photographs/videos for Madrasah publications, website and social media.

YesNo
Code of Conduct :

Code of Conduct: Students must observe madrasah dress code, punctuality, respect for teachers, and follow rules on behaviour and attendance. Repeated misconduct may lead to disciplinary action.
I have read and accept the Madrasah Code of Conduct

I Agree
Declaration: I declare that the information provided in this application is true to the best of my knowledge. I agree to comply with Madrasah policies on fees, attendance and discipline.
💡 Note: All payments should be made directly to the Madrasah account.

Please ensure you retain your payment evidence.

Bank Name: [JAIZ BANK]

Account Name: MIFTAHU AN-NAJAH QURAN.MEMORISATION AND ARABICS STUDIES.

Account Number: [0018607792]
Should be Empty:

MIFTAAHU AN-NAJAH MADRASAH REGISTRATION FORM

بِسْمِ اللَّهِ الرَّحْمَنِ الرَّحِيمِ MADRASATU MIFTAAHU AN-NAJAH, Shangisha Magodo, Lagos State. Nigeria

🧒 SECTION 1: STUDENT INFORMATION

SECTION 2 — GUARDIAN / PARENTINFORMATION

🩺 SECTION 3: EMERGENCY & MEDICAL INFORMATION

📚 SECTION 4: PROGRAMME(S) & FEES

📁 SECTION 5: REQUIRED DOCUMENTS (UPLOAD)

✍️ SECTION 6: CONSENT & DECLARATION

Code of Conduct :