Kelana Jaya Form - Test

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*

Occupation

Father's Name*

Father's Phone Number*

Father's Email*

Occupation

Home Address*

Select Primary Contact*

For billing and invoicing purposes

Mother
Father

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

Select Preferred Class*

Quranic Seedlings | Select a preferred time session*

Monday - Friday | 2.30 pm – 4.30 pm
Saturday & Sunday | 9.00 am – 11.00 am

Quranic Junior al-Hafiz | Select a preferred time session*

Monday - Friday | 2.30 pm – 4.30 pm
Saturday & Sunday | 4.00 pm – 6.00 pm

Get rewarded when you refer your family & friends

Introduce family and friends to iLuvQuran and enjoy up to 30% OFF your first month's fee!

Would you like to refer friends or family members?*

Refer up to 5 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*

Friend #4 - Name*

Friend #4 - Mobile number*

Friend #4 - Email address*

Friend #5 - Name*

Friend #5 - Mobile number*

Friend #5 - 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

iLuvQuran Kelana Jaya - Registration / Annual Fee*

Includes registration fee, facilities, equipments, learning and activities materials, report cards and assessments. Not include monthly fee.

Price: RM 1.00