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Student Details :
Parents / Guardian Details :
(Landline - Not Mobile)
(This number will be used as primary contact number)

When you are asked to sign the DD mandate for monthly fee, remember to use the same email that you enter here

Emergency Contact Details :
(Please provide an emergency phone number to contact in case of the above phone number's are not reachable)
Present Address :
  Yes, I’m a UK Tax Payer and I agreed to claim Gift Aid
Medical :
Does the student suffer from any serious or long-term illness, e.g. Epilepsy, Bronchitis etc?
Yes No   If ‘Yes’ please give details
Does the Student require any special (educational or other) needs?
Yes No   If ‘Yes’ please give details
Does the Student suffer from any allergies?
Yes No   If ‘Yes’ please give details
If required the following can be administered to the student
1. Paracetamol  
2. Antihistamine  
3. Over the Counter (OTC) drugs  
4. Please consent following
  1. Does Student Know Swimming  
  2. Travel sickness  
  3. Travel Permission  
  4. Photo Permission  
Transport :
Mode of transport that will be used by pupil to and from Madrasah:
Do you permit your child to go home alone : Yes No
Islamic Education History :
Already attended islamic education   Yes  No  If yes please provide details below
Please answer the following questions about your child´s Quran level as accurately as possible in order to optimise his/her learning progress.
  1. Is your child able to read the Arabic letters?
     Yes  No
  2. How would you describe your child´s reading level?
     Beginner  Intermediate  Advanced
  3. Is your child able to independently read fluently with correct tajweed?
     Yes  No
  4. Has your child memorised any portion of the Quran?   Yes  No  If yes, which surahs or how many ajzaa (parts)?
  5. Please describe your child´s Quran learning journey and list former teachers and Madrasahs (as detailed as possible)
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