Parent/Guardian Details

Parent/Guardian First Name*

Parent/Guardian Last Name*

Relationship to Child*
MotherFatherGuardianOther

Email*

Home Address*

City*

Post Code*

Home Tel

Mobile*

Emergency Contact Name*

Emergency Contact Number*

Other Notes

Parent / Guardian Consent

From time to time Al Falaq Academy may take photographs of pupils during a lesson or at our special events, and use these images on the academy website or other promotional material.

YesNo

Child Details

Child First Name*

Child Last Name*

Child Birth Date*

Gender*
MaleFemale

Child Current School

Academic School Year*
ReceptionYear 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11

Has the child attended Al Falaq Academy before?*
YesNo

Medical Needs, if any