iLuvQuran QBabies Class Registration

Student's Information

Student's Name*

Student's Age*

Student's IC*

Student's School*

Student's Recitation Level*

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

Which Branch Would You Like?*

Wangsa Melawati

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.

Joining Instructions*

The Parent shall be deemed to have accepted the terms and conditions set out in Joining Instruction Document further to delivery of Joining Instruction Document, and upon making any payment toward the registration of iLuvQuran classes or programs , unless explicitly stated otherwise in writing.