Student Admission Form

Student Registration Form

Fill out the form carefully for registration. One form per child.
Fees information:

All payments must be paid into our bank account at the start of each contract. Fees are paid quarterly. The fees are listed below:
Fees can be paid either by bank transfer or through online payment:

Bank details:

Account Name: Muallim Academy
Account Number: 16458268
Sort Code: 23-05-80

Link for online payment:

www.muallimacademy.org/feepayment
Name*

First NameLast Name
Relationship to the student*
Email*
example@example.com
Mobile Number*
Work or Secondary number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Details
Student Name*

First NameMiddle NameLast Name
Birth Date*

DayMonthYear
Gender*
Student mobile number (if any)
Current school:
Student E-mail (if any)
example@example.com
AthsmaCardiac diseaseHypertensionEpilepsyCancerDiabetesPsychiatric disorderAllergiesLearning difficultiesOther
If you ticked other, please specify what condition your child has below:
YesNo
If yes, please list them:
YesNo
If yes, please list them:
YesNo
Please specify if your child has prior Islamic/ Quranic knowledge. If yes, please give a brief outline of what they have already learnt.
Kids Quran and Islamic Studies MON to WED (5-6:30)Kids Quran and Islamic Studies SUN (10-12:30)Kids summer maktab/madrasah
Additional Comments
Signature
Should be Empty:

Student Registration Form