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Grassy Park Islamic

Educational Society
C/O Misrole Ave & Elizabeth Rd Grassy Park
Tel: 021 7052972
Est 1968 Rajab 1388 gpislamiceducare@gmail.com

Please provide your ID and childs Birth Certificate


MADRASSA & AFTERCARE
PUPILS DETAILS Child 1 Child 2
Surname
Name
D. O. B
Age
Home Address:

MOTHER: FATHER:
Surname:
Name:
ID no.
Occupation:
Employer:
Work tel:
Cell:
Home:
Email: Mother
Email: Father
Person responsible for fees __________________________________________________
Method of payment - (pls mark X) EFT ATM DEPOSIT

ALTERNATIVE CONTACT
Surname
Name
Relation to pupil:
Cell:
Home:
Email:

Comments/Suggestions etc.(Medical History, Learning Barriers - Please eloborate)

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