iLuvQuran Kelana Jaya Class Registration

Student's Information

Student's Name*

Student's Age*

Student's IC*

Student's School*

Recitation Level*

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

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:

Health/Medical Information

Eg: Allergies, personality or other particular important information we should know about your child.

Preferred Class

Select Preferred Class*

List of available classes at the moment:

Quranic Babies (2-3 years old) | Sunday, 9.30am -10.30am
Quranic Beginners (4-5years old) | Sunday, 11.00am -12.20 pm
Quranic Seedlings (5-8 years old) | Weekdays, 9:00am - 11:00am
Quranic Seedlings (5-8 years old) | Weekdays, 2:30pm - 4:30pm
Quranic Seedlings (5-8 years old) | Weekends, 9:00am - 11:00am
Quranic Junior Al-Hafiz (7-12 years old) | Weekdays, 2:30pm - 4:30pm
Quranic Junior Al-Hafiz (7-12 years old) | Weekdays, 9:00am - 11:00am
Quranic Junior Al-Hafiz (7-12 years old) | Weekends, 9:00am - 11:00am

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.

New Student

Coupon

Total

RM 0.00

By clicking 'Proceed with Payment', I hereby:*

Agree that all information provided to iLuvQuran Kelana Jaya regarding my child is true and I consent to iLuvQuran Kelana Jaya's Policy