EVENING MADRASAH

APPLICATION FORM

Our Children, Our Future

Please fill this form in as accurately as possible.

Father's Details

First Name

Surname

Mobile Number

Email

----------------------------------------------------------------------------------------------------
Mother's Details
First Name

Surname

Mobile Number

Email

Select Main Contact

----------------------------------------------------------------------------------------------------
Home Address
Address

Address Line 2

Town

County

Postcode

Home Number

----------------------------------------------------------------------------------------------------
Child's Details
First Name

Surname

Date of Birth

Select Child Gender
MaleFemale
Does this child have or had a sibling studying in this Madrasah
YesNo
----------------------------------------------------------------------------------------------------
Emergency Contact
First Name

Surname

Mobile Number

Email

Select Relationship to Child

Address

Address Line 2

Town

County

Postcode

----------------------------------------------------------------------------------------------------
Extra information
Please provide details of child's Islamic schooling, if any:

Please state child's medical needs (if any), and any other important information: