Required fields are marked *
Gender
Childs Name *
Date of Birth (DD-MM-Y) *
Previous School Attended *
Current Grade *
First Language *
Name *
Home Address *
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
---AfghanistanAlbaniaAlgeriaAndorraAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe
Work Address
Home Phone Number *
Work Phone Number
Mobile Phone Number
Email *
Family Doctor
---We have a family doctorWe do not have a family doctor
Please detail any Please detail any additional/special needs your child has: (please provide full details) *
Please detail any medical needs your child has: (Full details required; if medication is needed an additional medication form will need to be completed) *
Please detail any allergies your child has: (Full details required) *
Please detail any dietary requirements for your child: (Full details required) *
What are your childs favourite activities? *
Is there anything your child doesnt like (food, games etc) or is afraid of? *
Any additional information *
I consent for my child to attend this school; I understand that the school has policies and procedures and that there are expectations and obligations relating to both the school and myself and my child and I agree to abide by them. I give permission for Tarbiyah Learning to seek any necessary emergency medical advice or treatment in the event that my child is involved in a serious accident. I expect to be contacted immediately on the above mentioned telephone number(s). I confirm that the information given on all forms is correct and agree to notify the school staff of any changes therein. I understand that the information given on this application form is private and confidential and Tarbiyah Learning will not disclose any information to third parties without the written consent of the Parents/Guardians mentioned above. I have read and accepted the above conditions for my child applying to the Tarbiyah Learning High School Program.
Please leave this field empty.
