Madrasah Application Form

Branch
GlassgowAyr

Afecc Classes
AlimiyyahArabicCoffee ClubCertificate ProgrammeMadrasah Session 1Madrasah Session 2Mothers & Toddlers

Gender
MaleFemale

Application Date

Date of Birth

Forename

Surname

Address

Post Code

Nationality

Ethnic Origin

Languages Spoken
EnglishUrduArabic

Other Language

Previous Experience in Madrasah Classes

How did you hear of us?

Sibling in the Madrasah

Medical Conditions, Allergies, Special Needs or Disabilities

Forename

Surname

Address

Home Tel. No

Work Tel. No

Mobile No

Email Address

Forename

Surname

Address

Home Tel. No

Work Tel. No

Mobile No

Email Address

Name of Child

Please tick the appropriate box

I give consent to AFECC to administer either Paracetamol or Ibuprofen to my child if they feel unwell during class time.

Please tick which Medicine you consent to:

Paracetamol

Ibuprofen

Parent's Name (Print)

I do not give consent to AFECC to administer Paracetamol or Ibuprofen to my child.

Please specify which medication we can administer

Parent's Name (Print)

(Other Medication)

I give consent to AFECC to administer to my child.

Please specify which medication we can administer

Parent's Name (Print)