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In-Year Application Form
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* Indicates required question
Email
*
Your email
Child's Details
First Name and Legal Surname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Nationality
*
Your answer
Ethnicity
*
Your answer
First Language
*
Your answer
Other Languages Spoken
Your answer
Home Address (Inc postcode)
*
Your answer
Borough / Council
*
Your answer
Place of Birth
*
Your answer
Parental Responsibility?
*
Yes
No
Is or has your child
previously been in care of
a local authority?
*
Yes
No
If yes, Name of local authority
*
Your answer
Does your child have a statement of special educational
needs or EHCP?
*
Yes
No
If yes please give details of what the statement is for and the level of provision
*
Your answer
Name of current Nursery / School
*
Your answer
Address of current Nursery / School
*
Your answer
Date Started
MM
/
DD
/
YYYY
Date Left/Leaving
MM
/
DD
/
YYYY
Why have you chosen Iqra for
your child? (Please include any
special medical/social reasons)
*
Your answer
Medical / Social Report attached: YES [ ] NO [ ] (Please tick)
Yes
No
N/A
Clear selection
PARENT 1 DETAILS
First name and Legal Surname
*
Your answer
Gender
Male
Female
Clear selection
Relationship to child
*
Your answer
Home/Work tel
Your answer
Mobile Number
*
Your answer
Occupation
Your answer
Email address
*
Your answer
Do you have parental responsibility for the child?
*
Yes
No
Address (if different from child)
Your answer
PARENT 2 DETAILS
First Name and Legal Surname
*
Your answer
Gender
*
Male
Female
Relationship to Child
*
Your answer
Home/Work tel
Your answer
Mobile number
*
Your answer
Occupation
Your answer
Email address
*
Your answer
Do you have parental responsibility for the child?
*
Yes
No
Address (if different from the child)
Your answer
How many siblings currently attend or have attended Iqra?
Your answer
Names of siblings
Your answer
EMERGENCY CONTACT 1
[MUST NOT BE MUM OR DAD/MAIN CARER]
Full Name and Relationship to Child
*
Your answer
Their telephone number
*
Your answer
EMERGENCY CONTACT
[MUST NOT BE MUM OR DAD/MAIN CARER]
Full Name and Relationship to Child
*
Your answer
Their telephone number
*
Your answer
The School must be informed immediately should any of the above information change in any way.
Your answer
MEDICAL / DIETARY INFORMATION
Doctor’s Name and Address
*
Your answer
Lunch Arrangements
*
School Dinners (currently all meals are provided free of charge under the Mayoral Scheme)
Free School Dinners (separate application form required)
Packed Lunch
Equal Opportunity Monitoring Information
We are committed to equality of opportunity and are keen to monitor the effectiveness of our admissions
procedures. Any information provided on this form will be treated in the strictest confidence and will only be
used for the purpose of admissions monitoring.
*
White British
English
Gypsy or Irish Traveller
Irish
Scottish
Welsh
Other White background (specify if you wish)
African
Somalian
Caribbean
Other Black background (specify if you wish)
Asian
Asian / Asian British Bangladeshi
Chinese
Indian Pakistani
Other Asian background (specify if you wish)
Mixed
White and Asian White and Black
African
White and Black Caribbean
White and Chinese Other mixed background (specify if you wish):
Arab
Other ethnic group (specify if you wish):
I do not wish an ethnic background category to be recorded
A copy of your responses will be emailed to the address you provided.
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