Register

School *

Session

First Name

Last Name

Date of Birth

Gender

Name of state school

Name of last/current Islamic School

Discription of students reading abilities

Medical

Mothers Name

Fathers Name

Home Phone

Mothers Mobile

Fathers Mobile

E-mail Address: *

Language spoken at home

Door

House

Street

City

Post Code

Who will collect the child from school?

Do you give your child permission to travel alone? *

Emergency Contact - Name

Relationship to child

Emergency Contact Number

Where did you hear about the school?

Any other comments

* Required