MUL Application form

Student Details

First name(s)  
Surname  
Address  
Town
City
Postcode  
DOB  
Age  
Applying For Class Group  

Parent/Guardian details

Name  
Occupation  
Tel  
Mobile  
Relation To Student  
If the parents are seperated who is the legal guardian of the student?  

Previous School

Head Teacher  
Name Of School  
School Address  
School Email  
School Tel  

Your GP/Doctors details

Address  
Name  
Tel  
Does student suffer any ilnesses or disabilities?  
If YES please give details  

Previous Islamic Education Institute

Name of Institute  
Addres  
Postcode  
Teacher  
Tel  
Completed Nazara  
How Many Juz Memorized   

Emergency Contact

Contact Name  
Address including postcode  
Relation To Student  
Mob  

Decleration