Adult Urdu Course Annual Registration Form 2020

Please pay the term fees by visting https://www.almeezan.co.uk/adulturducoursetermfees before completing this form.
If you experience any technical difficulities in completing this registration form please contact Saira 07780361901.
Student Full Name *
Date of Birth e.g. 1/4/2003 *
Address *
Contact Number *
Emergency Contact Name and Number *
Any important dietary or medical information? *
Name of Doctor *
Doctor Address *
Doctor Contact Number *
Select which course(s) you are registering for. *
Required
Provide the payee name as it appears on Paypal or Bank account? *
Any additional comments for the admin team e.g. paying from someone elses account, paying on behalf of another student etc
CONSENT FOR MEDICAL TREATMENT. I hereby consent to my recieving medical treatment, if the staff or doctor thinks it is necessary in the event of an emergancy, if contact or parent can not be reached. *
Required
I agree to be photographed during class/events for use on the Al-Meezan website, social media and in publications for the duration of my attendance of the course. *
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