Madrasah 0116 266 6688
info@madrasahimambukhari.com

Masjid 0116 266 5506

Salah Timetable

Home
Our Madrasah
News
Events
Registration
Forms
Contact Us
Masjid

Loading…

Registration

Please complete the form in BLOCK CAPITALS using BLACK INK.
Please provide original copies of applicant’s birth certificate and parent / guardian’s proof of address.
Note: Incomplete application forms will be rejected.

Student Details

First name *

Middle name

Surname *

Gender *

Male

Female

Address *

City / Town *

Postcode *

Home Telephone

Date of Birth *

Age *

Name of Applicant’s School *

Full Time

Date of enrolment

Part Time

When is the applicant expected to start full time?

Date

Primary Parent / Guardian Details

First name *

Surname *

Address (if Different)

City / Town *

Postcode *

Mobile Tel Number *

Home Telephone

Email Address *

Relationship to Applicant *

Secondary Parent / Guardian Details

First name

Surname

Address (if Different)

City / Town

Postcode

Mobile Tel Number

Home Telephone

Email Address

Relationship to Applicant

Emergency Contact Details

First name *

Surname *

Address (if Different)

City / Town

Postcode

Mobile Tel Number *

Home Telephone

Email Address

Relationship to Applicant *

Medical Information

Name of Dr

Doctor’s Address

Postcode

Doctor’s Telephone Number

Does the applicant suffer from any serious long term illnesses? e.g. Epilepsy, Asthma

Yes

(if yes please give details)

Does the applicant suffer from any allergies?

Yes

(if yes please give details)

Does the applicant have any special (educational and other) needs?

Yes

(if yes please give details)

Previous Madrasah Education

Is your child currently attending or has he/she attended a Madrasah:

Yes

If YES please answer the questions below and provide as much detail as possible
Name and Address of Madrasah Attended:

Period of Attendance

Qur’aan: What is the child’s current stage of Qur’aan learning i.e. Qaidah or Juz / Para’s completed or memorised

Madrasah Imam Bukhari
159 Loughborough Road, Leicester
Leicestershire LE4 5LR

Phone : 0116 266 6688
Email : info@madrasahimambukhari.com