Madrassah Application Form

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Maktab and Hifdh Class

Child's First Name *

Child's Surname *

Gender *

Date of birth *

Enter child date of birth (Separate by / )

YYYY

First Line of Your Address *

Please enter your door and Road name

Second Line of your Address

Optional

Post Town *

Pick your Post Town

City *

Enter City

Post Code *

Enter Post Code

Landline (put mobile if you do not have landline) *

Enter Landline Number [NO SPACING BETWEEN NUMBER]

Mother’s Full Name *

Mother’s Mobile Number *

Enter your Mobile Number [NO SPACING BETWEEN NUMBER]

Mother’s Email Address *

Father’s full Name *

Father’s Mobile Number *

Enter your Mobile Number [NO SPACING BETWEEN NUMBER]

Father’s Email *

Parental responsibility *

Mother

Father

Both

Other:

Medical or Learning Difficulty Details *

If your child suffers from any medical conditions, behaviour issues, or learning difficulties,

If Yes *

Please give details:

Course *

Learn to Read Quran

Hifz

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 who your child will travel with, to and from Madrasah

If other than parents who will pick up and drop

Please specify below:

Parent or Guardian: *

Enter name parent or guardian:

Relationship to child *

Enter parent or guardian relations

Consent *

(A) I have read the Madrasa’s terms and conditions and agree to abide by the rules of the Madrasah

(B) I give permission for my child to attend the Chingford Madrassah and agree that my child will abide by the rules and regulations of the madrassah.

(C) I give permission for the people named above with parental responsibility and who have signed the relevant section to be contacted by phone or email in relation to any issues the madrassah has about my child. (Note: Chingford Madrasah will not sell your information to third-parties).

(D) Should there be any change to the details given on this form I understand that it is my responsibility to inform the Chingford Madras admin.

(E) 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.

(F) I agree to my contact details being held in the Madrassah’s communication system (to be signed by mother)

Required

Declaration *

Please select option YES if you are agree No if disagree

Yes

Submit

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