Admission Form

The personal information collected during registration will be stored to facilitate communication between the school and guardian(s).

Student Information

Student Name*
Student Date of Birth*
Sex*
Place of Birth*
Status in Canada*
Health Card No.
Phone No.
Address*

Student is applying for:

While studying at Darul Uloom Canada, students will also be enrolled in secondary school according to last grade level completed.

Select Program*

Class that you are applying for:

Untitled

Note: Boarding is only available for boys enrolled in Hifz, Alim or Ifta Courses.  Day School or Alimah Course is only available for local (Chatham) residents.

How did your hear about us?*

Educational Background

Provide a date range when student attended the school.  Prior to the interview, you will be asked to provide documentation and latest reports from the school.

Student has been attending (check all that apply):*
Last Grade Completed:*
Name of Institute /​ Madarsa*
Office Phone No.*
School Email*
How long did you attend this institute?*
Address*
Reason for leaving?*
Nazira Completed
How much Quran has been memorised?*

Secular Education

Only give information about the most recent school that the student was enrolled in

Name of Institute /​ School*
Office Phone No.*
School Email*
How long did you attend this institute?*
Address*
Reason for leaving?*
Grade Levels studied at the school:*

Home Schooling

You will need to submit a home schooling waiver from your local school board.

Reason for Home Schooling*
Nazira Completed*
Grade Levels studied:*
How much Quran has been memorised?*

Parent/Guardian Information

Information about Mother and Father is required. If the applicant has only one parent or guardian, you must explain the circumstances in order for the application to be processed.

Parent/Guardian 1

Name*
Home Address*
Citizenship:
Personal email*
Home Phone No.
Mobile No.*
Relation to applicant*
Occupation*
What is your relationship to the applicant*
Applicant only has one parent?

Information about Mother and Father is required if 'No' is selected. Click the 'Add Parent/Guardian' to add the second parent.

Please explain briefly:*

Medical Health Record and Contact

Same as Parent/​Guardian

For student medical information & history please fill out our Medical Form separately.

Emergency Contact

Name*
Relation to Student*
Phone No.*
Address*

Miscellaneous Information

Student has been attending (check all that apply):*
Provide details if any of the above have been selected:*
Is there a custody order?
Who has custody?

Declaration of Accuracy

I herby certify that the information provided herein is true and accurate. I understand that is my responsibility to inform the school of any changes to the information provided in this form immediately.  I understand that the applicant once accepted will be admitted to the school on a three month probation.  The applicant and I accept and agree to abide by the rules & regulations of Darul Uloom Canada.  This application, if accepted, will be for the current academic school year and parents are required to re-enroll the student for the next academic year.

Have you read the declaration?
Signature
Date*

DARUL ULOOM CANADA

51 Prince St. N, Chatham, ON  N7M 4J7
Tel: 519-360-1028     Fax: 519-360-1023     Email: office@ducanada.org     website: www.ducanada.org
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Please fill out the admission form or contact us for any enquiries.

Providing comprehensive Islamic education and fostering a strong Muslim community since our establishment.

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