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Madrasah Enrolment form
Step
1
of
7
- Pupil Information
14%
Comments
This field is for validation purposes and should be left unchanged.
Pupil information
Full Name
Date of birth
MM slash DD slash YYYY
Gender
Male
Female
Address
Street Address
City
ZIP / Postal Code
Main contact
Name
Relationship to Child
Phone
Email
Additional Contact
Name
Relationship to Child
Phone
Emergency Contact
Name
Relationship to Child
Phone
Family Information
Siblings currently attending this Madrasah:
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Father's Name
Mother's Name
Medical & Educational Needs
Does your child have any learning difficulty or additional support needs?
Yes
No
If yes, please provide details:
Does your child suffer from any medical condition or illness?
Yes
No
If yes, please provide details:
Is your child taking any regular medication?
Yes
No
If yes, please describe:
Consent & Declaration
I, the parent/guardian of the above-named student, confirm that all information provided is accurate. I have read and understood the Madrasah’s rules and agree that my child will adhere to its policies and guidelines
Parent/Guardian Name
Date
MM slash DD slash YYYY
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