Escolar Documentos
Profissional Documentos
Cultura Documentos
Surau Al-Hikmah, Jalan SS 18/4, 47500 Subang Jaya, Selangor Darul Ehsan
No PENDAFTARAN JAIS 13S(8)4/45 Kod Sekolah BYA8248
: ____________________________________________________
Passport/I.C. No.
: ____________________________________________________
Date of birth
: ____________________________________________________
Fathers name
: ____________________________________________________
Mothers name
: ____________________________________________________
: ____________________________________________________
____________________________________________________
Email address
: __________________________________________
(Most future correspondence shall be via email)
EDUCATIONAL RECORD
School attended (or furthest secular education) ________________________________
Level achieved _______________________________________ in the year _________
Madrasah attended (or furthest Islamic education) ______________________________
Level achieved _______________________________________ in the year _________
HEALTH
Does the applicant suffer from any illness that would affect his studies or his stay at the
institute? If yes, specify.
________________________________________________________________________
A guardian is person responsible for the student for the period of time outside madrasah. A
guardian of a female student should be a muhrim.
Guardians name
Fees Card
All students shall be issued a FEES Card. In each occasion, please make sure that the
recipient of the fees is a member of the staff and signs the card to acknowledge the
respective payment. All payments should be made to:
I, the undersigned, testify that all that are submitted above as true.
I am applying on behalf of the above mentioned student to enroll at this institution.
I understand the Rules and Regulation of the Madrasah and agree to abide by it.
I, in my capacity as the PARENT/GUARDIAN/SPONSOR of the student mentioned
above, hereby undertake to pay the fees as indicated above
o I am responsible for the arrangement of the students visa.
o I hereby agree that:
1. The parents shall not intervene in the operation of the madrasah. Any feedback must
be addressed to the mudir in writing.
2. The madrasah will do its utmost to take care of the students safety, but is NOT
responsible for any mental or physical harm that may befall the student for all time
during the stay in the madrasah or away from the madrasah.
3. Punctuality is of high importance. Disciplinary action shall be taken on students
returning late to the madrasah.
4. Any item(s) found in possession of the student, which have been ruled impermissible
by the madrasah, will be confiscated. It is entirely up to the madrasah to do what is
deemed necessary with the confiscated item(s). The parents have no more rights
over the item(s).
5. The madrasah will inform the student and may update the parents of the items which
have been declared impermissible by the madrasah.
6. The madrasah has the right to expel the student who is found to be unfit,
academically or behaviourally, to continue his/her study in the madrasah.
We put our trust in Allah swt.
Signature of parent/guardian/sponsor
: _______________________________________
: _______________________________________