MASJID ASSYAKIRIN psn me aoe HOME BASED ISLAMIC LEARNING (HBIL) REGISTRATION FORM. PART A: MAIN APPLICANT'S PERSONAL PARTICULARS Ful Nara BLOCK ETERS WRENS ania Sa Natenaty Genser PART: APPLICANT'S REQUIREMENTS Cotegory: 1 Children 5.12 yeas) 1 Dewasa (17 years & above) [Teenagers 13-18 yeas) © Femi mixed Tota! No of Students: Subjects un 2 sec ‘Neuen: 0 kyo © Towa © Tetoaa thes: 1 Fahibadoh 6 Tauhid basic} Arabic Language Time & Day 1 sexor~ snow: © Moming Aftemoon 1 Evening 5 Monday 6 Tuesccy > Wednesday Thursday 0 doy Gender of Teacher: Starting Date: Students* Data Marsden person) No Full Name NRE No | Gender | Age‘PART: POINTS 10 NOTE Preare reas corefuly |. A nonrefundable $20.00 registration fe s oppicable, 2. Fees of $5500 o be paid crecty fo the HBL Teacher a the end of eact sesion 3.__Applicant can ony choose c maximum of two (2) subjects in each sesion 4, Number of participants faking part per session in each household should not be more than sh (6) persons 5. Amount wal not be adusted as long as the number of pattcipanis in the household remains tha some, 5. Alnofica of changes of ie, day, place, number of participants. etc rust be noted to Hall Officer two (2) weeks in edvance before any changes can be mode 7. Al equess for change of Hl. Teachers and concetation of clases to ke communicated {HEIL Offices one (1) month in advance. 8. Both appicont and Hall Teacher to sign the Attendance and Payman!shest ater each Eons nog nt yceuton sperm xen oa ay ‘ang rer on rca dcr ng eb honed Taos ‘esata Gn nr meses yee bg PART: DECLARATION | doctor thal he poriculs stated above ere tue and corsct to he bast of my belt and knowledge. | ‘fe hewo reas ond understood he contenisof hs regshasion andana be oblae byl Senet ate For Official Ure ‘Amount Receipt Ne: Offcer's Nome bate: Teacher's Name: start Dates