Alim Course (16+) Form

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DETAILS OF APPLICANT
Forename (s)
Surname
Please tick the time you wish to joinFor ladies only
D.O.BDate of Birth (dd/mm/yyy)
Age
Address
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Post Code
Telephone Number
Mobile
Occupation
Emergency Contact Name
Emergency Contact Number
Do you suffer from any medical condition or health issues? If yes please give details:
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Previous Islamic Education

Please give details of any previous Islamic education including any knowledge of the Arabic language.
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I confirm that all information provided is correct.
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