• 28 January 2025
  • 28 Rajab
  Fajr Dhur Asr Maghrib Ishā
Begins 6:04 12:18 2:55 4:46 6:23
Jamā‘ah 7:00 1:00 3:30 4:48 7:30

Application Form

 

Please fill all details and submit. All details will be automatically emailed to us.

Student & Parent/Guardian Information.

Student Information
First Name/s
Surname
Date of Birth
Year Group
Address
Postcode
Ethnicity
Parent/Guardian 1 Information
Title
Fullname
Home Phone
Mobile/Work
Address
Postcode
Relation to pupil
Email
Do you wish to be primary contact?
 Yes  No  N/A
Parent/Guardian 2 Information
Title
Fullname
Home Phone
Mobile/Work
Address
Postcode
Relation to pupil
Email
Do you wish to be primary contact?
 Yes  No  N/A
 

Alternative Emegency Contacts

Ist Emergency Contact
Title
Full Name
Home Phone
Mobile / Work
Address
Post Code
Relation to Pupil
2nd Emergency Contact
Title
Full Name
Home Phone
Mobile / Work
Address
Post Code
Relation to Pupil
 

Student Medical Information.

GP Information
Name of GP
Practice Name
Practice Tel
Fax
Address
Postcode
Medical conditions & Allergies
Does the student have any ongoing medical conditions?
 Yes  No
Allergies?
 Yes  No
If yes to either of the above, please provide details
Conditions
Treatment
Medication
Is there anything the madrasah should be aware of relating to the students health and wellbeing? Please detail below
 

Photography Consent

We may wish to take photographs of activities that involve your child to celebrate their work and achievements. The photographs may be used for displays, publications and on a web-site by us, by the Local Authority (LA) or by newspapers. Photography or filming will only take place with the permission of the head teacher and under appropriate supervision. Before taking any photographs of your child, we need your permission. Please complete, sign and date the form below. You may withdraw your consent, in writing, at any time.

I DO give permission for pictures of my child to be taken and displayed in the school and published "official" School social network feeds as well as on school, Local Authority or press websites.
I DO NOT give my permission for any pictures to be taken of my child to be used inside or outside the school.
Do you give permission for your child to be NAMED on any internal or external publications?
 Yes  No