First Line of Your Address Including Your Door Number *
Please enter first line of your address including your door number
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Second Line of Your Address
Optional
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Post Town *
Pick your Post Town
City *
Enter City
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Post Code *
Enter Post Code
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Landline (put mobile if you do not have landline)
Enter Landline Number [IGNORE IF YOU DO NOT HAVE IT]
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Mobile Number Mum *
Enter your Mobile Number [NO SPACING BETWEEN NUMBER]
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Mobile Number Dad *
Enter your Mobile Number [NO SPACING BETWEEN NUMBER]
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Email Address: *
Enter email address
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Parental responsibility *
Medical or Learning Difficulty Details *
If your child suffers from any medical conditions, behaviour issues, or learning difficulties,
If Yes
Please give details If your child suffers from any medical conditions, behaviour issues, or learning difficulties,
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Are you applying for *
Session one Mon 5-7pm, Wed 5-7, Fri 5-6 | Session two Tue 5-7, Thu, 5-7, Fri 6-7 | Sunday 10am to 2pm (Subject to Availability)
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Session one Maktab
Session two Maktab
Sunday Maktab
Hifiz Class
Do you have other children currently enrolled in Madrasah? *
Please tell us any children of your already in Maktab
If Yes
Please enter all children name below
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Who will Drop and Pick up your Child *
Please select who your child will travel with, to and from Madrasah
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On their own
With Parent or Guardian
Other
If other than parents who will pick up and drop
Please specify below:
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Parent or Guardian Name: *
Enter name parent or guardian:
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Relationship to child *
Enter parent or guardian relations
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Mother
Father
Guardians
foster parents
Career
Has your child completed Nazirah (recital) of the Qur’an? *
Has your child memorised any surahs/juz of the Qur’an? *
If Yes, which surahs/juz
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Has your child taken any lessons in Tajweed? *
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
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Photograph and video consent
I consent to my child appearing in photographs/videos for the following Maktab use. Please tick either Do or Don't for each option.
I give permission to take photographs and or video of my child
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I give permission to put my child's photographs and or video On the Maktab Website, Prospectus and Social Media
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I agree to my contact details being held in the HHMCT communication system
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Declaration
I have read the above Maktab Policy, Term and Condition. I here by agree to abide by the Rules and Regulations of the Maktab, also have clear knowledge of General data Protection Regulation (GDPR) of Higham HIll Maktab and I undertake the responsibility to bring and collect my child at the appointed times and pay the correct fee per month per child.
• Fees must be paid during absence, as the child’s place will be kept reserved. • Fees must be paid in one month advance.
By signing this form you are fully agreed to the terms & conditions of Higham Hill Maktab.
How did you heard about us *
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Letter box flyer
Bill board
Google search
Word of mouth
Recommended by someone
Facebook
Twitter
Instrogram
WhatsApp messages
Declaration *
Please select option YES if you are agree No if disagree