Child - Personal Details Form

   السلام عليكم و رحمة الله و بركاته

As part of the ongoing changes and effective implementation of the Online Payment System at Madrasah Naqeebul Islam we need to gather some vital information in regards to your Child(ren).

If you have multiple children attending please complete one form per Child.

Please enter your Child’s personal details - As accurately as possible.

Jazaka Allah

Madrasah Shura 

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Child’s Forename (First Name) *
Child’s Middle Name (If applicable)
Child’s Surname *
Child’s Date of Birth *
MM
/
DD
/
YYYY
Child’s Address - First Line of Address *
Child’s Address - Second Line of Address
Child’s Address - Town/City *
Child’s Address - Post Code *
Child’s Gender *
Required
Child’s Ustaad/Apa *
Child’s Classroom *
Please select the classroom where your Child attends Madrasah. Please note GB denotes Girls Building.
Is the Father (Primary Male Guardian) a Member of Masjid E Tauheedul Islam? *
Father’s (Male Guardian) Name *
Father’s (Male Guardian) Contact Number *
By adding your number you are providing consent to communication from the Madrasah in relation to your child. This will include receiving Madrasah Broadcast messages via Whatsapp.


(To receive broadcast messages you will need to save the Madrassah Broadcast number - 07871 815586).
Father’s (Male Guardian) Email Address *
Mother’s (Female Guardian) Name *
Mother’s (Female Guardian) Contact Number *
By adding your number you are providing consent to communication from the Madrasah in relation to your child. This will include receiving Madrasah Broadcast messages via Whatsapp.

(To receive broadcast messages you will need to save the Madrassah Broadcast number - 07871 815586).
Mother’s (Female Guardian) Email Address *
1.Emergency Contact Information - Name *
Please add the name of the primary emergency contact for your Child.
1.Emergency Contact Information - Relationship to Child *
Please add the relationship of the primary emergency contact for your Child
1.Emergency Contact Information - Address *
Please add the address of the primary emergency contact for your Child
1.Emergency Contact Information - Number *
Please add the contact number of the primary emergency contact for your Child
2.Emergency Contact Information - Name *
Please add the name of the secondary emergency contact for your Child
2.Emergency Contact Information - Relationship to Child *
Please add the relationship of the secondary emergency contact for your Child
2.Emergency Contact Information - Address *
Please add the address of the secondary emergency contact for your Child
2.Emergency Contact Information - Number *
Please add the contact number of the secondary emergency contact for your Child
Does your child have a Medical Condition the Madrasah needs to be aware of.
Please list any medication they may need in case of an emergency. Also any allergies they may have. 
Please enter the details for your Childs Doctors GP *
Please enter the name, address and contact number for the Doctors Practice where your Child is registered.
By ticking this box you accept you have completed this form accurately, consenting for this data to be used by Madrasah Naqeebul Islam. *
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