ICEC Childrens Islamic Education Classes Application Form ICEC Childrens Islamic Education Classes Application Form ICEC Childrens Islamic Education Classes Application Form Child's Forename(s) * Child's Surname * Gender * MaleFemale Date of Birth (dd/mm/yyyy) * Address Line 1 * Address Line 2 Town / City * County * Post Code * Name of School * Does your child have any Special Educational Needs (SEN)? * No Yes (Please provide details below) Details Does the child have any Disabilities / Medical Conditions / Allergies? * No Yes (Please provide details below) Details Does your child take any regular medication? * No Yes (Please provide details below) Details Which Madrasah class(es) are you applying for? (Please select one option) * Boys - Tuesday, Thursday and Friday (3 days): 5:00pm-6:00pm Boys - Tuesday, Thursday and Friday (3 days): 6:00pm-7:00pm Boys - No Preference Please select who your child will travel with (to and from classes): * With Parent/Guardian. (If you select this, we will not let your child out of the gates until Parent/Guardian arrives) On their own. (By selecting this option, you are consenting to allow your Child out of the gates at home time without supervision) Other. (Please explain below) Details Full Name of person filling this form * Relationship to Child * FatherMotherGrandfatherGrandmotherBrotherSisterUncleAuntOther Phone Number - Mobile (No Spaces) * Phone Number - Land Line (No Spaces) Email * Emergency Contact 1 - Full Name * Emergency Contact 1 - Mobile Number (No Spaces) * Emergency Contact 1 - Relationship to Child * Please SelectFatherMotherGrandfatherGrandmotherBrotherSisterUncleAuntOther Emergency Contact 2 - Full Name Emergency Contact 2 - Mobile Number (No Spaces) Emergency Contact 2 - Relationship to Child Please SelectFatherMotherGrandfatherGrandmotherBrotherSisterUncleAuntOther DECLARATION: I, the Parent/Guardian of the above mentioned child confirm that all the information provided in this Admission form is true to the best of my knowledge. I agree to abide by the IC&EC Children's Madrasah Admission Policy and fully accept and understand that my child will be expected to abide by all rules and regulations laid down by IC&EC Madrasah. (31st March 2023) * Tick to Acknowledge If you are human, leave this field blank. Submit Δ