Evening Madrasa Application Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child Name *FirstLastDate of Birth *MM/DD/YYYYGender *MaleFemaleAddress *full address with postcodeParent / Guardian Name *FirstLastAddress (If different)full address with postcodeParent/Guardian Email *Parent/Guardian Phone * have Medical Emergency Contact Person Name *FirstLastEmergency Contact Person Phone *Please Provide name and contact details of a responsible adult who we can contact in an emergency in case we cannot get hold of you.Classes *Wednesday to Friday – (GMT 5pm – 6:30pm, BST 5:30pm – 7pm)GMT 11am –1pm, BST 11:30-1:30pm)Does the child have any medical condition? *YesNoPlease specify any Medical Condition or any AllergyDoes your child have any Special Educational need or Disability? *YesNo If yes please tell us how we can support your child in our MadrasaPhotographyYesNoWe may use photograph or video of your child/children for display or promotional materials; do you permit us to use 2 6 6 their photograph for stated reason.Declaration *I declare that the information given above are correct. I accept and agree with terms and policies of the Madrasa. I will make sure that my Son/Daughter will abide by the rules and disciplinary policies of the Madrasa.Submit
