– Alimiyyah

– Arabic

– Certificate Programme

– Madrasah Session 1

– Madrasah Session 2

– Mothers & Toddlers

– Other

AFECC Classes:

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Madrasah Al-Farooq Education Department

(Evening School)

Application Form

Please fill in this form correctly and hand it into the Office.

Gender:

Male [ ] Female [ ] Application Date:

[ ][ ]/[ ][ ]/[ ][ ] (i.e. [D][D]/[M][M]/[Y][Y])

Date of Birth:

[ ][ ]/[ ][ ]/[ ][ ] (i.e. [D][D]/[M][M]/[Y][Y])

Forename:

Surname:

Address:

Post Code:

Nationality:

Ethnic Origin:

Languages Spoken:

English [ ] Urdu [ ] Arabic [ ] Other: __________________________________

Previous Experience in Madrasah Classes:

How did you hear of us?

Sibling in the Madrasah:

Medical Conditions, Allergies, Special Needs or Disabilities that we should be aware of:

PARENT/GUARDIAN

Forename:

Surname:

Address:

Home Tel. No:

Work Tel. No:

Mobile No:

Email Address:

EMERGENCY CONTACT

Forename:

Surname:

Address:

Home Tel. No:

Work Tel. No:

Mobile No:

Email Address:

Parents Signature:

Date:

OFFICE USE ONLY

DH Id Number:

ST Id Number:

RI Id Number:

Date of Admission:

Course:

Added to Madrasah Phn: Y / N

Timings:

Class Assigned:

Comments:

Gift Aid Form:

Yes/No

Was an interview carried out:

Yes/No

Assigned to Raziil: Y / N

Excel Fee Record: Y / N

Student Record: Y / N

Excel Register: Y / N

Assigned to Islamic Studies:

Yes/No

Documents Reviewed & Filed:

Y / N

Admin Signature:

Assistant Head Signature:

Head Signature:

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