Madrassah Application Form – Wybourn Islamic Centre

Madrassah Application Form

Child Details

Full Name

Date of Birth

Gender Gender

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Parent’s/Guardian’s Details

Full Name

Relationship to child

Address

Postcode

Home Telephone

Mobile Phone

Email

Child/ren already attending Madrasshah

Do you have any child/ren already attending the Madrassah? If yes, state their name(s):

Other Information

Please list below any medical conditions we need to be aware of, e.g. Allergies, Asthma, Diabetes etc

Does your child have any Special Educational Needs? If yes, please provide details

Please specify your child's current school

Emergency Contact Details

Full Name

Relationship to child

Address

Postcode

Home Telephone

Mobile Telephone

Declaration

Key points to keep in mind:

I have read and understood the admissions policy, Madrassah rules, GDPR statement and Terms and Conditions. If offered a place at UKIM Wybourn Islamic Centre, I agree to abide by all rules and regulations of the Madrassah, current and in the future.

If you are human, leave this field blank.