Student Enrolment Form - Academic Year 2025/2026

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Student applications for Dar-Us-Salam Educational & Spiritual Institute (Madrassah) operating from Noor-ul-Islam Mosque, Bury.

This form is only for NEW students wishing to be enrolled for the 2025/26 academic year.

If you have any questions or concerns, please message the dedicated education line: 07862270377

Child's Full Name (incl. any middle names) *

Child's Date of Birth *

YYYY

Child's Age *

Child's current school year: *

Gender *

Female

Male

Father's Full Name: *

Father's Contact Number *

Mother's Full Name *

Mother's Contact Number *

Address (incl. postcode) *

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship to child *

Parent's Email Address *

Names of any siblings already attending Madrassah classes:

Medical Conditions *

Additional Learning Needs? *

Yes

Any Comments

Are you a Mosque Member? If yes, please fill in the remaining sections.

Yes

Clear selection

Mosque Members Full Name: (Note: Existing membership MUST be under one of the parents’ names and CANNOT be another family member (i.e. grandfather, uncle etc) - If NEW member, please state in the box below *

Member's date of birth:

YYYY

Payment Method:

Cash

Standing Order (Through the bank)

Clear selection

Payment Term:

Weekly

Monthly

Yearly

Clear selection

Payment Date:

YYYY

Payment Amount:

Membership Start Date:

YYYY

Submit

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