MMD

1

Child details

Tell us about the child applying for a Non-Reception place.

Child's first name *Child's surname *Date of birth *Age on 01/09/2027: —The child must be over 6 years 0 months, with a maximum age of 15 years 11 completed months on 01/09/2027.Gender *Address line 1 *Address line 2Town / city *Postcode *Home telephoneDoes the child currently attend school? *Birth certificate *PDF, JPG or PNG, up to 4 MB. Certificates in any language are accepted. Those that cannot be checked automatically will be marked for manual staff verification.

2

Parent details

Provide the main contact and an optional second parent or guardian.

Parent 1

Full name *Relationship *Email *Secondary emailMobile number *Address same as child? *

Parent 2

Full nameRelationshipEmailSecondary emailMobile numberAddress same as child?

3

Emergency contacts

Add another trusted adult the institute may contact in an emergency.

Emergency contacts (optional)

Add the details of another trusted adult the institute may contact in an emergency.

Emergency contact 1

NameRelationshipAddressPostcodeMobile numberTelephone number

4

Previous Madrasah information (optional)

All fields are optional. Leave this section blank if your child has not attended another Madrasah.

Previous Madrasah nameTown / cityNumber of years attendedReason for leavingQur’an learning covered so farInclude the Qa’idah stage, surahs or juz read, and any memorisation, if known.Other relevant information

5

Additional information

Check the final details and submit the application.

Previous Madrasah information

Not provided (optional).

Any disability or medical condition? *Is there a disability, allergy, serious condition or learning difficulty we need to know? Give full details. If none, enter NONE.

Is the child involved with Social Services? *Does the child have an SEN statement or plan? *Does the child attend, or previously attended, speech therapy? *Preferred session *May the institute offer the other session? *

I confirm the information is accurate and consent to the institute using it to process this application. *

Read the Privacy Policy (opens in a new tab)I have read and agree to the Privacy Policy and consent to the institute using the information provided to process this application. *