Online Student Registration Form - Madrasah Al Hikmahsj
A. REGISTRATION INFORMATION
APPLICATION FOR SCHOOL*
FOR INTAKE YEAR*
FOR LEVEL FORM/YEAR*
PREFERRED SESSION* Preferred Session Will Be Finalized By Management
PREVIOUS SCHOOL
B. STUDENT INFORMATION
Student Name*
Citizen
IC No/Passport* (No Space and Dash '-')
Birth Cert. No
Birth Place* Others
Birth Date*
Gender/Race/Religion*
Tel. Mobile* (Parent) (No Space and Dash '-')
Email (Parent)
Eg. mel@yahoo.com
Tel. Home
Home Address (Line 1)*
Home Address (Line 2)
City*
Postcode* Others
Illness/Alergic

 Others (Specify)
 
Untitled Document
C. FATHER INFORMATION
Name*
IC No*
Occupation*
Address
Tel. Mobile* (No Space and Dash '-')
Tel. Home
Tel. Office Fax:
Email
Eg. mel@yahoo.com
D. MOTHER INFORMATION
Name*
IC No*
Occupation*
Address
Tel. Mobile* (No Space and Dash '-')
Tel. Home
Tel. Office Fax :
Email
Eg. mel@yahoo.com
F. FOR EMERGENCY CONTACT (Beside Parent)
 Name*
 Relation*
 Tel. Mobile* (No Space and Dash '-')
 Tel. Home
 Tel. Office
 Fax
 Email
Eg. mel@yahoo.com
Untitled Document
G.
(UPSR)
(Please Tick the Related Subject Only)
SCHOOL NAME*
EXAM YEAR*
- BAHASA MALAYSIA PEMAHAMAN
- BAHASA MALAYSIA PENULISAN
- BAHASA INGGERIS
- SAINS
- MATEMATIK
- PEKA
- FARDU AIN
- PEKA
- FARDU AIN
2. OTHER EXAMS (IF ANY)
SCHOOL NAME
YEAR
EXAM NAME
  Subject Grade/Result
1
2
3
4
5
6
7
8
9
10
3. CO-CURRICULUM INFORMATION
  Sports/Clubs/Associations Position Level School/District/State/Country
1
2
3
4
5
4. QURANIC INFORMATION
Quran Reading Fluency Good   Average   Weak
Reading Jawi skills Good   Average   Weak
Writing Jawi skills Good   Average   Weak
Has been Khatam Quran Yes   No.
If NOT, How many Juz already?
Ever memorize quran Yes   No.
If YES, How many Juz has been memorized?

I, here with agreed that all information given is correct. Madrasah Al Hikmahsj has the rights to reject without prior notice. Thank you.