Qamar Institute Registration Form
Intended Year of Study *
Name *
Your answer
Surname *
Your answer
Date of Birth *
Your answer
Cell Phone Number *
Your answer
Home/Landline Number (or any alternate contact number)
Your answer
Email 1 *
If you do not have an email address, please enter the email address of a close relative or friend.
Your answer
Email 2
Enter a 2nd email address, if you have a 2nd email address. Otherwise leave this blank.
Your answer
Occupation *
Your answer
Previous Islamic / Arabic Studies *
Your answer
Highest Academic Achievement *
Your answer
Ability to Recite Quran *
Residential Address *
Your answer
Postal Address *
Your answer
Postal Code *
Your answer
Year of Study *
Which class are you applying for?
Are you able to afford the monthly fees? *
If partly, enter the amount under 'Other'
Payment method *
Do not do cash deposits at banks as they are more difficult to process • Select one of the options below.
EMERGENCY CONTACT DETAILS
Name of Contact Person *
Your answer
Emergency Number *
Your answer
Comments
Indicate anything further which you feel we should know about.
Your answer
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