Al Barakah School - Adult Classes & Class 11 Registration Form
As-salāmu ʿalaykum 

Welcome to Al Barakah School. 

Please complete this form if you would like to sign up to any of the following classes for adults at Al Barakah School:

1. Islamic Studies Class for Brothers (10am-1pm) - Onsite / Online

2. Tafseer Class for Sisters (10am-12pm) - Onsite / Online

3. Seerah Class for Sisters (12-12.50pm) - Onsite / Online

4. Class 11 Beyond Al Barakah  (10am-1pm) - Onsite only

Details of our Adult classes and Class 11 can be found on our website: https://www.albarakah.co.uk/news-posts/adult-courses/ 

Note: This form MUST be completed and submitted in order to secure your place on the course. Please provide a personal email address rather than a work email address where possible.

Any queries can be directed to admissions@albakarah.co.uk. JazakAllahkhair.

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Email *
Class *
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First Name *
Surname *
Gender *
Date of Birth *
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Address *
Post Code *
Home Telephone Number
Mobile Telephone Number *
Emergency Contact 1 - Full Name *
Emergency Contact 1 - Relationship to you *
Emergency Contact 1 - Telephone/Mobile Number *
Emergency Contact 2 - Full Name *
Emergency Contact 2 - Relationship to you *
Emergency Contact 2 - Telephone/Mobile Number *
Name of Doctor and GP Surgery *
Do you suffer from any medical conditions? If yes, please give details in the next question. *
Please specify what medical conditions you have, including any medication taken that the school might need to be aware of.
Do you have any allergies? If yes, please give details in the next question. *
Please specify what allergies you have, how severe the allergies are, and whether or not you are at risk of Anaphylaxis or carry an EpiPen / other adrenaline auto-injector.
Do you suffer from asthma? If yes, please give details in the next question. *
Please specify the severity of your asthma, and what medication (if any) you take for it.
Do you suffer from epilepsy? If yes, please give details in the next question. *
Please specify the severity of your epilepsy, and what medication (if any) you take for it.
Do you suffer from eczema? *
Do you suffer from hayfever? *
Please provide any other information that may be useful including any medical issues not specified above, special educational needs, learning or behavioural difficulties, personal or family circumstances etc. This will help Al Barakah School provide the best learning outcomes for you.
Al Barakah School shall not be responsible for any loss or damage caused to personal property in the course of you attending classes or other events organised by the school. Payment of fees must be made termly or monthly regardless of attendance. By submitting this form, you confirm that: you acknowledge and agree to abide by the above terms; the information you have provided is true; and you consent to Al Barakah School holding and processing your personal data in a lawful and secure manner. *
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By completing this registration form you understand that you will be registered for your preferred course at Al Barakah School, and will be charged the relevant fees. To unregister or leave at any point, you must email admissions@albarakah.co.uk.  *
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A copy of your responses will be emailed to the address you provided.
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