Madrassah Application Form
Maktab and Hifdh Class
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Are you applying for *
Child's First Name *
Child's Surname *
Gender *
Date of birth *
Enter child date of birth (Separate by / )
First Line of Your Address *
Please enter your door and Road name
Second Line of your Address
Post Town *
Pick your Post Town
City *
Enter City
Post Code *
Enter Post Code
Landline (put mobile if you do not have landline) *
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 *
Medical or Learning Difficulty Details *
If your child suffers from any medical conditions, behaviour issues, or learning difficulties,
If Yes *
Please give details:
Session *
Session one 4:30 - 5:30 | Session two 5:30 - 6:30. | Hifz   4:30PM - 6:30PM
Do you have other children currently enrolled in Madrasah? *
Please tell us any children of your already in Maktab
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
Has your child completed Nazirah (recital) of the Qur’an?
Clear selection
Has your child memorised any surahs/juz of the Qur’an?
Clear selection
If Yes, which surahs/juz
Has your child taken any lessons in Tajweed?
Clear selection
Consent *
I here by agree to abide by the rules and regulations of the Madrasah  and I undertake the responsibility to pay the fee of  £28 per month per child for Maktab and £56 per month for hifz.

• Fees must be paid during absence, as the child’s place will be kept reserved.
• Fees must be paid one month in advance.
Declaration *
Please select option YES  if you are agree No if disagree
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