Request edit access
Madrassah Application Form
Maktab, Hifdh Class,Islamic Studies and Arabic Language
Sign in to Google to save your progress. Learn more
 Maktab Policy, Term and Condition
Before filling out the application form, please click on the link to review the Maktab Policy and Terms and Conditions.
First Name *
Middle Name
Last Name *
Gender *
Date of Birth *
Enter child date of birth (Separate by / )
MM
/
DD
/
YYYY
First Line of Your Address  Including Your Door Number *
Second Line of Your Address
Optional
Post Town
Clear selection
City *
Post Code
 *
Landline (put mobile if you do not have landline)
Enter Landline Number [IGNORE IF YOU DO NOT HAVE IT]
Mobile Number Mum *
Enter your Mobile Number  [NO SPACING BETWEEN NUMBER]
Mobile Number Dad *
Enter your Mobile Number  [NO SPACING BETWEEN NUMBER]
Email Address: *
Enter email address
Parental responsibility *
Medical or Learning Difficulty Details *
Is your child has any medical conditions, behaviour issues, or   suffers from  Allergies
If yes
If yes give details
Other Medical Condition *
If your child suffers from any these following medical conditions
Are you applying for *
Session one Mon 5-7pm, Wed 5-7, Fri 5-6 | Session two Tue 5-7, Thu, 5-7, Fri 6-7 | Sunday 10am to 1pm (Subject to Availability)
Do you have other children currently enrolled in Madrasah? *
Please tell us any children of your already in Maktab
If Yes
Please enter all children name below
Who will Drop and Pick up your Child *

Please select the person responsible for transporting your child to and from Madrasah.

If other than parents who will pick up and drop
Please specify below:
Parent or Guardian Name: *
Enter  name parent or guardian:
Relationship to child *
Enter  parent or guardian relations
Has your child completed Nazirah (recital) of the Qur’an? *
Has your child memorised any surahs/juz of the Qur’an? *
If Yes, which surahs/juz
Has your child taken any lessons in Tajweed? *
In the unlikely event of illness or accident I give permission for any necessary emergency first aid or medical treatment to be given. In an emergency and if I am not contactable, I am willing for my child to receive hospital treatment. I understand that every reasonable effort will be made to contact me as soon as possible
Clear selection
Photograph and video consent
I consent to my child appearing in photographs/videos for the following Maktab use. Please tick either Do or Don't for each option.
I give permission to take photographs and or video of my child
Clear selection
I give permission to put my child's photographs and or video On the Maktab Website, Prospectus and Social Media
Clear selection
I agree to my contact details being held in the HHMCT communication system
Clear selection
Declaration
I have read the above Maktab Policy, Term and Condition. I here by agree to abide by the Rules and Regulations of the Maktab, also have clear knowledge of General data Protection Regulation (GDPR) of Higham HIll Maktab and I undertake the responsibility to bring and collect my child at the appointed times and pay the correct fee per month per child.

• Fees must be paid during absence, as the child’s place will be kept reserved.
• Fees must be paid in one month advance.

By signing this form you are fully agreed to the terms & conditions of Higham Hill Maktab.
Declaration *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms