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Madrassah Application Form
Maktab and Hifdh Class
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* Indicates required question
Are you applying for
*
Maktab
Hifdh Class
Other:
Child's First Name
*
Your answer
Child's Surname
*
Your answer
Gender
*
M
F
Date of birth
*
Enter child date of birth (Separate by / )
MM
/
DD
/
YYYY
First Line of Your Address
*
Please enter your door and Road name
Your answer
Second Line of your Address
Optional
Your answer
Post Town
*
Pick your Post Town
Choose
Walthamstow
Chingford
Highams Park
Wood Street
City
*
Enter City
Your answer
Post Code
*
Enter Post Code
Your answer
Landline (put mobile if you do not have landline)
*
Enter Landline Number [NO SPACING BETWEEN NUMBER]
Your answer
Mother’s Full Name
*
Your answer
Mother’s Mobile Number
*
Enter your Mobile Number [NO SPACING BETWEEN NUMBER]
Your answer
Mother’s Email Address
*
Your answer
Father’s full Name
*
Your answer
Father’s Mobile Number
*
Enter your Mobile Number [NO SPACING BETWEEN NUMBER]
Your answer
Father’s Email
*
Your answer
Parental responsibility
*
Mother
Father
Both
Other:
Medical or Learning Difficulty Details
*
If your child suffers from any medical conditions, behaviour issues, or learning difficulties,
No
If Yes
*
Please give details:
Your answer
Course
*
Learn to Read Quran
Hifz
Do you have other children currently enrolled in Madrasah?
*
Please tell us any children of your already in Maktab
Yes
No
If Yes
Please enter all children name below
Your answer
Who will Drop and Pick up your Child
*
Please select who your child will travel with, to and from Madrasah
Choose
On their own
With Parent or Guardian
Other
If other than parents who will pick up and drop
Please specify below:
Your answer
Parent or Guardian:
*
Enter name parent or guardian:
Your answer
Relationship to child
*
Enter parent or guardian relations
Choose
Mother
Father
Guardians
Foster parents
Career
Has your child completed Nazirah (recital) of the Qur’an?
Yes
No
Clear selection
Has your child memorised any surahs/juz of the Qur’an?
Yes
No
Clear selection
If Yes, which surahs/juz
Your answer
Has your child taken any lessons in Tajweed?
Yes
No
Clear selection
Consent
*
(A) I have read the Madrasa’s terms and conditions and agree to abide by the rules of the Madrasah
(B) I give permission for my child to attend the Chingford Madrassah and agree that my child will abide by the rules and regulations of the madrassah.
(C) I give permission for the people named above with parental responsibility and who have signed the relevant section to be contacted by phone or email in relation to any issues the madrassah has about my child. (Note: Chingford Madrasah will not sell your information to third-parties).
(D) Should there be any change to the details given on this form I understand that it is my responsibility to inform the Chingford Madras admin.
(E) In the unlikely event of illness or accident I give permission for any necessary emergency first aid or medical treatment to be given. In an emergency and if I am not contactable, I am willing for my child to receive hospital treatment. I understand that every reasonable effort will be made to contact me as soon as possible.
(F) I agree to my contact details being held in the Madrassah’s communication system (to be signed by mother)
Required
Declaration
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
Yes
No
Submit
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