Al Madrasah Al Muhammadiyyah - Dubai

Al Madrasah Al Muhammadiyyah - Dubai Registration (Form B – New Student) - Academic year – (2012-2013) The following is required for your child’s Madrasah registration for the year 2012-2013: a) Completed Registration Form b) Payment of all outstanding membership fees of KSIMC Dubai c) Student’s valid passport copy with visa page d) Dhs 300 (to be paid once the registration has been approved – not along with this form) Please note: Effective June 2012, children of paid KSIMC Dubai members only will be eligible to register for Madrasah Al Muhammadiyyah. Student’s Full Name: Father’s Full Name (as per KSIMC Dubai membership):

Mother’s Name:

Date of Birth:

Nationality:

Student Email Address: (if any)

Student’s Mobile:

Father’s Mobile:

Mother’s Mobile:

Mother’s Email:

Father’s Email:

Last Madrasah attended, Class

Allergies:

School Name:

Curriculum (e.g. IGCSE)

Residence Tel:

Passport Number:

Passport Expiry:

Visa Number:

Visa Expiry:

Fees: The Annual Administration fee per student is AED 300 and is payable within 2 weeks of getting the admission approval email from the Madrasah Admin. All fees collected are on behalf of KSIMC Dubai and may be used (if needed) for the various KSIMC funds available.

I agree to fully abide by the Rules and Regulations of Al-Madrasah Al-Muhammadiyyah Parent / Guardian Signature:

Date:

FOR OFFICIAL USE:

KSIMC Dubai Membership Confirmation:

Form Accepted on ____________________

Membership Number: ________________

Admin Signature: _____________________

Verified by: __________________________

Receipt: We confirm receiving the form for student _____________________ without the fees.

Date: _________________________________ Thank you. Madrasah Admin

Signature of recipient _____________________