Application Form

Completing the form does not mean you have a place.

Fill in the form as accurately as possible and with correct spellings.

Father Father’s First Name* Father’s Last Name* Father’s Email* (required for online services) Father’s Mobile

Mobile Number and Email Address must be unique for each parent

Mother Mother’s First Name* Mother’s Last Name* Mother’s Email (required for online services) Mother’s Mobile*

Address: Address* Town* County* Postcode* Home Phone* (Landline Only)

Who is the main contact? MotherFather

Please ensure full contact details are available for the main contact

Child: * Child: First Name * Child: Last Name * Child: Date of Birth Please Select Child Gender MaleFemale
Does this child have or had a sibling studying in this Madrasah YesNo

Alternative Contact: Alternative Contact: First Name Alternative Contact: Last Name Alternative Contact: Mobile Select Relationship to Child Address Town County Post Code Home Phone (Landline Only)

Notes: Please provide info about your child’s previous madrasah education (if they have attended a madrasah previously): Please provide all medical information, including asthma and allergies:

Before submitting, please ensure correct spelling.