CIL Youth 25/26 - Registration Form

CIL Youth Programme 25/26

(If you require a sibling discount code, please register 1st child and then email cil@wycombemosque.com with your request details)
Student Full Name*

Only one preferred First NameOnly one preferred Last Name
Age*
Date of Birth*

DayMonthYear
Gender*
School Year from September*
Starting in September
School of Attendance from September*
Starting in September
Medical Conditions*
Food Allergies*
Any Special Educations Needs (SEN)*

YesNo
Please provide further information regarding SEN*
Has your child attended CIL Youth previously?*

YesNo
Previous CIL Youth class*

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CIL Youth Programme 25/26