S.H.I.A MADRESSA
2174 Belgrave Street N.D.G Montreal Quebec H4A 2L8, CANADA
Tel: 514-483-1273 Fax: 514-483-0167 Email: shia.madressa@gmail.com
Student Name
Date of birth
Father Name
Gender
Male
Female
Mother Name
Address
City
Postal Code
Email:
Home Phone
Mobile #
Work Phone
Would you like to receive WhatsApp Notification on your Mobilephone?
In case of Emergency, please contact
Phone
Relationship to Student
Medical Consent Form
Medical Inshurance Card Number
Expiry Date
Medical Conditions / Allergies
If your child possesses any medical condition or allergy, please provide details below.
Please coordinate with Shia Madressa for Fee and confirm your registration.
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