Madrassah Application Form

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Maktab, Hifdh Class,Islamic Studies and Arabic Language

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 / )

YYYY

First Line of Your Address Including Your Door Number *

Second Line of Your Address

Optional

Post Town

Walthamstow

Chingford

Highams Park

Wood Street

Other:

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 *

Mother

Father

Both

Medical or Learning Difficulty Details *

Is your child has any medical conditions, behaviour issues, or suffers from Allergies

Yes

If yes

If yes give details

Other Medical Condition *

If your child suffers from any these following medical conditions

Autism Spectrum Disorder (ASD)

ADHD (Attention Deficit Hyperactivity Disorder)

None Above

Other:

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

Yes

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? *

Yes

Has your child memorised any surahs/juz of the Qur’an? *

Yes

If Yes, which surahs/juz

Has your child taken any lessons in Tajweed? *

Yes

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

Yes

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

Yes

Clear selection

I give permission to put my child's photographs and or video On the Maktab Website, Prospectus and Social Media

Yes

Clear selection

I agree to my contact details being held in the HHMCT communication system

Yes

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 *

Yes

Submit

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