iLuvQuran Bangi Class Registration

Student's Information

Student's Age*

Please enter a number greater than or equal to 1.

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*

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

Monthly Fee*

Price: RM 0.00

Deposit (1 Month Fee)*

Price: RM 0.00

Hidden

Boy QS-JAH*

Hidden

Girl QS-JAH*

Annual Fee*

Price: RM 0.00

Discount*

Price: RM 0.00

Enjoy a RM50 discount before the end of November

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!

#1 Friend/Family - Name*

#1 Friend/Family - Phone*

#1 Friend/Family - Email*

#2 Friend/Family - Name*

#2 Friend/Family - Phone*

#2 Friend/Family - Email*

#3 Friend/Family - Name*

#3 Friend/Family - Phone*

#3 Friend/Family - Email*

Payment

Coupon

Total

iLuvQuran Bangi Class 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