Madrassah As-Salaam Registration

New Student Registration Form

Please fill in all required fields to help us with processing your child’s application quickly.

* 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:

Add medical info/notes

Mobility & Access

Please let us know of any access / mobility requirements your child may have that the Madrassah needs to be aware of and help accommodate

Allergies (required)

Please tell us about any allergies your child has that we need to be aware of. State NA if Not Applicable

Child Collection (required)

Who will be responsible / has authority to collect your child at the end of the Madrassah day? (Please state relationship to child)

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.

By submitting this form, you agree to Madrassah As-Salaam storing and using your data and that of the child, for the purposes of processing your Madrassah application. We will only keep your data if your application proceeds and is successful. For more information, please contact us on madrassah@masjidsalaam.co.uk

I consent that IBEUK can process this form and submit directly to Madrassah As-Salaam. Your data will not be stored nor used by us.

Please press the following buttons in order to confirm you're not a bot: