The Qur'an Summer Camp

Thank you for your interest in 'The Qur'an Summer Camp'. Applications are open to Male students above the age of 14 only. Please fill in the below form with the required information and attach the required documents.

The fee for the course is £250.

Section A - Personal Details

Name*

Surname (Family Name) Forename(s)

Date of Birth*

DD

MM

YYYY

Age*

Nationality*

Address*

Street Address Address Line 2 City County Post Code Country

Mobile*

Home Telephone

Email*

Father's Details*

Surname (Family Name) Forename(s) Telephone

Section B - Further Details

Do you have any disability, health condition or dietary requirement that we should be aware of:*

Yes
No

*

If Yes, please give details;

Do you have any criminal convictions or reprimands, or have you ever been charged with an offence:*

Yes
No

*

If Yes, please give details;

Are you or have you been a member, follower or supporter of any organisation or group, whether religious, political or otherwise?*

Yes
No

*

If Yes, please give details;

How would you describe your cultural and ethnic origin?*

Please indicate if you speak any other languages aside English, and the level (written, spoken):

Section C - Referee Details

Referee 1

Name*

Surname (Family Name) Forename(s)

Organisation*

Position*

Address*

Street Address Address Line 2 City County Post Code Country

Telephone

Email*

Known to applicant as:*

Any relation to applicant:*

Referee 2

Name

Surname (Family Name) Forename(s)

Organisation

Position

Address

Street Address Address Line 2 City County Post Code Country

Telephone

Email

Known to applicant as:

Any relation to applicant:

Section D - Documents

Please attach a copy of your;

1. Passport / Photo ID
2. Proof of Address

Section E - Declaration

I declare that the information given on this form is correct. I also agree that if accepted onto 'The Quran Summer Camp', I will abide by all its terms, conditions and regulations set out by Jamia Al-Karam.

I acknowledge that all fees are non-refundable and that Jamia Al-Karam reserves the right to terminate my enrollment onto the course for any reason it may see fit without notice. I understand I must meet the standard expected of me in conduct and character as well as in academic studies and within the residential environment and the institution community as a whole.

I have read and agree to the declaration.

Signed by Applicant

Date