Essex Jamme Masjid Academy Registration

Please fill the details student(s) to our waiting list. For more information, please contact us about this form.

* denotes required field

*Your name: (Parent/Guardian)

*Surname:

*Relation to student: Autofill: Father Mother Brother Sister

Type:

*Your email:

*Confirm email:

Parent Portal Password:

Confirm password:

If you already have an account and a password, you can skip this and leave it blank. Otherwise you should set your password now to login to the parent portal now.

Telephone:

*Mobile:

*Address: *Postcode:

Students

Student #1:

Surname:

D.O.B:

Gender:

Email:

*Enroll:

Nazrah & Islamic Studies Suitability: School going children Aged 4 upwards  Timings: Sat-Sun 9:45am – 1:30 pm (After Zuhr Salah)

Add medical info/notes

Medical Conditions

General Notes

500 remaining

S.E.N (required)

Does your child have special educational needs?

Does not apply

Attention deficit hyperactivity disorder (ADHD)

Emotional and behavioural difficulties (EBD)

Autism (ASC) Support

Specific learning difficulties

Speech, language and communication needs

Physical & mobility difficulties

Social and emotional mental health needs

Sensory

Communication difficulties

Medical needs such as Epilepsy and Cerebral Palsy

Other

Contacts

You are the primary contact. You can add more contacts below.

Additional Contact #1

Contact Name:

Email:

Tel.:

Parent Portal Password:

Confirm:

Mobile:

Alt. Mob.:

Relation:

Type:

Primary Contact? This means the contact will receive emails related to the student. The contact will also see the student on the parent portal to view progress and other information. If you select no here, this contact will not see the student on the parent portal.

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