iLuvQuran Semenyih Registration

Student's Information
Student's Name*
Student's Age*
Student's IC*
Student's School*
Parent's Information
Mother's Name*
Mother's Phone Number*
Mother's Email*
Mother's Occupation*
Mother's Monthly Income*
Father's Name*
Father's Phone Number*
Father's Email*
Father's Occupation*
Father's Monthly Income*
Home Address*
Select Primary Contact*
For billing and invoicing purposes
- Mother
- Father
Emergency Contact
Your child will only be released to an authorised person listen on this form (parents/guardian and/or emergency contacts). In case of emergency or an unforeseen circumstance, please indicate the person(s) you authorised to pick up your child on your behalf. A parent/guardian's verbal authorisation for pickup must be received before your child can be released to anyone listed here. If you received and if we cannot notify you by phone, the child will not be released.
Name*
Relationship*
Phone Number*
Survey
Where did you find out about our class?*
What are your expectations from the class?
If Other, please specify:
Other specific important information we should know?

e.g: medical or health info such as allergies or special need
Preferred Class
Quranic Junior Al-Hafiz | Available time session*
- Monday - Friday | 4.00 pm – 6.00 pm
Get rewarded when you refer your family & friends
Introduce family and friends to iLuvQuran and enjoy up to 15% OFF your first annual's fee!
Would you like to refer friends or family members?*
Refer up to 3 names. Fill in the details below and we'll contact them via email as soon as possible.
- Yes, definitely!
- No, thank you for the offer.
Friend #1 - Name*
Friend #1 - Mobile number*
Friend #1 - Email address*
Friend #2 - Name*
Friend #2 - Mobile number*
Friend #2 - Email address*
Friend #3 - Name*
Friend #3 - Mobile number*
Friend #3 - Email address*
Please tick the box for confirmation*
- I agree and confirm that I have read, agreed and hereby consent to the collection and processing of my information and my friend's personal information/personal data and the information you have provided is accurate and correct.
Payment
Product Name*
Price:
Discount 50%(initial price: rm359): Includes registration fee, facilities, equipments, learning and activities materials, report cards and assessments. Not include monthly fee, eportal (rm9), surah book(rm9.90)
Total
RM 0.00
Payment Method*
- FPX / Online Banking / Billplz

iLuvQuran Semenyih Registration

Student's Information

Parent's Information

Emergency Contact

Survey

Preferred Class

Get rewarded when you refer your family & friends

Payment

PHYSICAL CLASS

ONLINE CLASS