• UKIM Madina Masjid, Keighley
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Madrassah Application Form

Before completing the application form below, you must read and understand the admissions policy, Madrassah rules and GDPR statement. Please also make sure you complete all of the relevant fields and provide accurate information.

Admissions Policy and Madrassah Rules     GDPR Statement

Child’s Details

Full Name:
Date of Birth:
Gender:

Parent’s / Guardian’s Details

Full Name:
Relationship to child:
Address:
Postcode:
Home Telephone:
Mobile Phone:
Email address:
Do you have any child/ren already attending the Madrassah?
If yes, state their name(s):

Other Information

Please list below any medical conditions we need to be aware of, e.g. Allergies, Asthma, Diabetes etc:
Does your child have any Special Educational Needs?
If yes, please provide details:
Please specify your child’s current school:

Emergency Contact Details

Full Name:
Relationship to child:
Address:
Postcode:
Home Telephone:
Mobile Phone:

Declaration

© 2020 UKIM Madina Masjid, Keighley