DETAILS OF APPLICANT First Name * Last Name * Gender * —Please choose an option—MaleFemale Date of Birth (dd/mm/yyyy) * Address * City * Postcode * Mobile Number * Email * Occupation * Emergency Contact Name * Emergency Contact Number * Do you suffer from any medical conditions or health issues? * YesNo Please provide details of relevant health issues. Previous Islamic Education * Please give details of any previous Islamic education including any knowledge of the Arabic language Do you want to be considered for entry into higher years of the course on the basis of your previous studies? Please note that acceptance into a higher year is subject to an entry procedure and remains entirely at the discretion of Al Kawthar Academy. noyes How did you come to hear of this course? Online advertisementYouTube ChannelWebsitePoster in shopWord of mouthOther I confirm that all information provided is correct. *
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