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Mohammed Ali Court (gloria fast food),

3eme Étage, rue desforges, Port-Louis


M. JUNID PEERUN

Student Registration Form


Date

Personal Information

Name of Student

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Age: ……………. Gender: ☐ Male ☐ Female DoB : ………………………….

Contact Information

Address

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Tel: ……………………… Mobile: ………………………… Email: …………………………………….........

Class schedule Information

☐ 6 am to 7 am ☐ 4pm to 6.30 pm ☐ After Esha to 9pm

Comments: ………………………………………………………………………………………………………………………….....

Signature and Date

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