Registration Form

Enter your details

Admission Application No.

Select Child's Name

Language Spoken At Home

Present School(if Applicable)

Family - Section A

Marital Status of the Child's Parents:

If Other, Then Select:

Child Lives With

Who has the Legal Custody of the Child?

Medical

Was there any complication at the time of birth ? No Yes If yes, please explain


Does the child have any of the following medical conditions :
Physical Neurological Muscular Psychological
Learning Difficulties Phobia of Allergies Asthma
Disability Holds Breath Fits Other
Please provide relevant documents and additional details at the time of assessment.

Is the child under regular medication ? No Yes If yes, please provide details.
Doctor's Name:	Doctor's Clinic/Hospital:
Doctor's Cell Phone:	Doctor's Work Phone:

Name:	Relationship:
Home Phone:	Work Phone:	Cell Phone:

Provide details of family member/relative who have studied/are studying or have worked/are working at Al-Huda