Madrasah-Tul-Madina

Date: 20-06-2025 06:42 am

Section 0 - Select Region and Madrasah

Gender

Male

Female

Select Region^*

Select Madrasah^*

Section 1 - Child's Details _{(We collect this information to identify the child and to send any correspondence)}

First Name^* Last Name^*

Middle Name Date of Birth^*

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House No & Addres^*

Post Code^*

Email

Previous Madrasah attended^*

Reason for Leaving^*

Other children already studying at this Madrasah? ^*

Section 2 – Parent / Guardian Details _{(We collect this information to contact parents/guardians as detailed in consent section of this
form)}

1st Parent/Guardian Details

First Name^*

Middle Name

Last Name^*

Relationship to Child^*

Contact Details^*

Parental Responsibility

Yes

No

2nd Parent/Guardian Details

First Name

Middle Name

Last Name

Relationship to Child

Contact Details

Parental Responsibility

Yes

No

Section 3 – Other local contacts _{(New safeguarding guidelines require us to have alternative contacts if parents or guardians are
unavailable. These individuals will only be contacted if we are unable to get through to the parents.
These individuals must know the password you have provided in this section)}

First Person Details

Full Name^*

Contact Details^*

Second Person Details

Full Name

Contact Details

Third Person Details

Full Name

Contact Details

Password^*

Section 4 – GP Details _{(This information is required to communicate with the GP in an Emergency or as part of supporting
your
child’s health needs)}

Name of GP^*

Surgery ^*

Contact Details^*

Post Code^*

Full Address^*

Section 6 – Additional Information _{(Please provide any additional information that you feel is important for the admission of your
child)}

Additional Information

Section 7 – Consent _{(Under the new General Data Protection Regulations (GDPR), we are required to have specific consent
from the parents for the following statements. You have every right to withdraw your consent by circling
NO and this will not adversely affect your child’s admission. You must sign each statement even if you
choose not to give consent.)}

1- Madrasa-tul-Madinah can share my contact details with other departments of Dawat-e-Islami for the purpose of sharing religious information, advertising works of Dawat-e-Islami and fundraising campaigns.

Yes

No

2- Madrasa-tul-Madinah can take photographs or make videos of my child and share them for educational and promotional purposes on Madani Channel, Social Media, news articles and other social networks as appropriate.

Yes

No

3- If my child is over the age of 10, I hereby give my express consent for him/her to walk home on their own and absolve Dawat-e-Islami of all responsibilities and liabilities in this regard.

Yes

No

Parent / Guardian _{(To be signed by the parent / guardian prior to submitting the form)}

I have read The Madrasa-tul-Madīnah Handbook completely.
I fully understand the policies and procedures mentioned in The Handbook.
I agree to abide by all the rules and regulations mentioned in The Handbook.
I confirm that all the details I have provided in the admission form are true and accurate.
I will inform the Madrasa-tul-Madīnah of any changes immediately in writing.