ISD Madrasah Registration Form

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ABN: 45 993 783 034

PO Box 41151 Casuarina NT 0811 ∙ 53 Vanderlin Drv, Wanguri NT 0810 Email: info@isod.com.au

Please fill the form with correct information. JazakAllahu khairan - ISD Management

Email *

First Name
*

Part 1: Student Details

Last Name
*

Part 1: Student Details

Date of Birth
*

Part 1: Student Details

YYYY

Gender *

Part 1: Student Details

Male

Female

Telephone/Mobile (if applicable)

Part 1: Student Details

Home Address
*

Part 1: Student Details

Post Code: *

Part 1: Student Details

Year Level at School, (i.e., Pre-school, Transition, Year 1-12) *

Part 1: Student Details

Arabic reading ability (tick most appropriate)

Part 1: Student Details

Reads Qur’an with tajweed

Still learning Arabic Alphabet

Somewhere in between

Required

Father/Guardian’s Name *

Part 2: Parents Details

Contact Number *

Part 2: Parents Details

E-mail Address
*

Part 2: Parents Details

Mother/Guardian’s Name *

Part 2: Parents Details

Contact Number *

Part 2: Parents Details

E-mail Address *

Part 2: Parents Details

Full Name *

Part 3: Emergency Contact (apart from parents)

Relation to Student *

Part 3: Emergency Contact (apart from parents)

Contact Number *

Part 3: Emergency Contact (apart from parents)

Medical Condition *

Part 4: Miscellaneous

Other Concerns *

Part 4: Miscellaneous

I hereby agree to abide by all the rules and regulations of the Islamic Society of Darwin and the madrasah. *

Part 5: Declaration

Yes

Parent/Guardian’s Name *

Part 5: Declaration

Date *

Part 5: Declaration

YYYY

How did you first find out about the madrasah?
*

Part 6: Survey

Family/ Friends

Announcement

Poster

Website

SMS

Required

Photographs of classes, event etc. are taken at the ISD Madrasah. These are posted onto the ISD website, social media (Facebook, Youtube), newsletters etc. Are you happy for your child’s photographs to be taken and used on these platforms?

If "No", please advise your child to remove themselves from these platforms or inform the person in charge so appropriate arrangements are made.

Yes

Other:

Clear selection

Waiver of Liability *

In consideration of my child’s participation in the Weekend Islamic School of Darwin, run under the aegis of the Islamic Society of Darwin, I, acting as parent or legal guardian of said child, hereby agree to release, discharge, waive and hold harmless the Weekend Islamic School of Darwin, Islamic Society of Darwin and its employees, agents, instructors, board members, volunteers, staff, leadership, owners or advisors for any incident, actions or conduct resulting in personal injury, accident, or illness to my child, not limited to negligence, gross negligence and recklessness.

I expressly agree that the forgoing waiver of liability is intended to be as broad as is permitted by the laws of the Northern Territory and Australia and if any portion therefore is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.

I have carefully read and voluntarily sign this waiver of liability and fully understand its contents and meaning as a full waiver of all claims, liability and indemnity against the Weekend Islamic School of Darwin, the Islamic Society of Darwin or any of its employees, agents, instructors, board members, volunteers, staff, leadership, owners or advisors. I hereby agree to abide by all the rules and regulations of the school.

Yes

Parent/Guardian’s Name *

Waiver of Liability

The information I have provided above is true and correct (Statutory Declaration, Legal action will be taken if found misleading) *

Yes

I agree that my submitted data is being collected and stored *

Yes

Our Ref. (Office Use Only)

Islamic Studies Class (Office Use Only)

Qur’an Studies Class (Office Use Only)

Date of Registration (Office Use Only)

Responsible Person (Office Use Only)

Date received (Office Use Only)

YYYY

Date entered in database (Office Use Only)

YYYY

Updated email (Office Use Only)

Yes

Clear selection

A copy of your responses will be emailed to the address you provided.

Submit

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