Application Form

Please complete all fields marked (*)

Check List for Application Form *

I have completed all sections of the form.

Pre-admissions forms (Madrasah / Quran Teacher & from child’s full-time school) completed

I the Parent/Guardian have signed the KS1 SATs (Primary) / KS2 SATs (Secondary) application form.

How did you hear about us?

Student Details

Student First Name(s) As In Birth Certificate *

Last Name *

Date of Birth *

Age *

Gender *

Male

Female

Other

Year Group Required

Please select *

Al-Mizan Primary School YEAR 3

Al-Mizan Primary School YEAR 4

Al-Mizan Primary School YEAR 5

Al-Mizan Primary School YEAR 6

LEA Secondary School YEAR 7

LEA Secondary School YEAR 8

LEA Secondary School YEAR 9

LEA Secondary School YEAR 10

LEA Secondary School YEAR 11

Preferred Start Date *

Student Details

Full Address

Post Code

Telephone

Mobile

Ethnicity

Nationality

Religion

Languages spoken at home

Medical History (i.e. Asthma,Epilepsy and is the child taking any medication):

Is your child identified as needing SEN Support (Special Educational Needs Support)?

Does your child have an EHCP (Educational Health Care Plan)?

Has your child received any additional support in the last six months under SEN Support/Inclusion?

Does your child have an Early Help Assessment (EHA) Plan?

Has your child had contact with the Child and Family Service or Child and Adolescent Mental Health services (CAMHs)?

Has your child been issued with a Child in Need (CIN) or Child Protection (CP) status in the last twelve months?

Does your child have any other needs that we should know about?

Does your child have any siblings currently attending our schools?

CURRENT EDUCATION

School Name

Full Address

Post Code

Telephone

E-mail

Teacher

Head Teacher

Year Group

Evening/weekend Madrasah Attending

Madrasah Address

Madrasah Teacher

Madrasah Head Teacher

Parent/Carers

Name of Father (or Carer)

Father's Full Address (If different to above)

Father's Post Code

Father's Telephone

Father's Mobile

Father's Email

Father's Occupation

Father's Telephone(work)

Name of Mother(or Carer)

Mother's Full Address(If different to above)

Mother's Post Code

Mother's Telephone

Mother's Mobile

Mother's Email

Mother's Occupation

Mother's Telephone(work)

EMERGENCY CONTACTS (Two Contacts Required)

Name

Emergency Contact 1 - Full Address

Emergency Contact 1 - Post Code

Emergency Contact 1 - Telephone

Emergency Contact 1 - Relationship to child

Emergency Contact 2 - Name

Emergency Contact 2 - Full Address

Emergency Contact 2 - Post Code

Emergency Contact 2 - Telephone

Emergency Contact 2 - Relationship to child

Statement Of Reason For Application - Parent

Why do you want your child to attend this school?

(Parent/Carer Should Write Here)

Statement Of Reason For Application - Child

Why do you want to attend this school?

(Applicant Should Write Here)

PRELIMINARY AGREEMENT

I understand that all children must adhere strictly to schools' code of conduct and values at all times.

As a parent/carer, I agree to follow the schools rules and regulations on all matters related to the school.

I will follow due protocols for suggestions and complaints.

I will pay for any damages caused by my child during his/her attendance at school.

I will endeavor to adopt any home-school support structure to assist the applicant in developing Islamic adhaab & aklaq as well as their academic progress.

I confirm that the information given above is correct to the best of my knowledge and that if any information changes, I will notify the school immediately. *

Your Full Name

Relationship to Child

Please provide a signature.