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
Tick the conditions that apply to your child:

AthsmaCardiac diseaseHypertensionEpilepsyCancerDiabetesPsychiatric disorderAllergiesLearning difficultiesOther
If you ticked other, please specify what condition your child has below:
Does your child have allergies ?

YesNo
If yes, please list them:
Does your child take any medication ?

YesNo
If yes, please list them:
Photo permission

YesNo
Please specify if your child has prior Islamic/ Quranic knowledge. If yes, please give a brief outline of what they have already learnt.
Courses
Additional Comments
Signature

Clear
Should be Empty:

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Student Registration Form