Registration Form For Madrasah 2021 (Joo Chiat Branch)
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Email *
SECTION A: Student's Particulars
Name *
(as in official documents)
Birth Certification Number *
required for Littlelives application
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Mother Tongue *
Nationality *
Home Address *
Home Number
Child's Contact Number (If Any)
Current School Attending *
Is this the student's first time applying to Nur Insan Weekend Madrasah? *
SECTION B: Student's Islamic Education Background
Is this the child's first formal exposure to Islamic education? *
Please provide details of former Madrasah (If Applicable)
(name of institution  / teacher)
Name of current sibling(s) in Nur Insan (If Applicable)
SECTION C: Student's Special Needs
Does your child require special attention / assistance in learning? *
If YES, please provide details below
Does your child have any illnesses or allergies? *
If YES, please provide details below
SECTION D: Next of Kin / Parents Particulars
Name *
Relationship to Student: *
Mailing Address (If Different from Child's Home)
Email Address *
Home Number
Handphone Number *
Emergency Contact Number if above is unavailable *
How did you know about Nur Insan? *
Do you wish to apply for Nur Insan's Book Assistance? (50% - 100% Waiver depending on eligibility) *
You will be requested to submit relevant documents upon registration confirmation
A copy of your responses will be emailed to the address you provided.
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