Madrassah Application Form

Student Details

First Name(s)

Surname

Gender

Male Female

Date of Birth

House Number

Street/Road

City/Town

Postcode

Home Phone

Father's Phone

Mother's Phone

Guardian's Name

Relationship to Student

Contact Name

Relationship to Student

Contact Number

Madrassah

Reason for Leaving

Quran Level

Qa'ida Naazarah Hifz

Quran Completed

0 Times 1-2 Times 3+ Times

Illnesses

Requirements

Allowed to go home alone

Yes No

Explain Going home option

School Attending

Yes No

Preferred Time

1st shift 5pm to 6:30pm 2nd shift 6:30pm to 8pm Hifz class 5pm to 8pm

Do you give consent for us to provide First Aid for your child?

Yes No

Do you give consent for us to take photographs of your child to use on our website/promotions?

Yes No

Do you give consent for us to take your child on trips/outgoings?

Yes No

I agree to the Madrassah rules and regulations