بِسْمِ اللهِ الرَّحْمٰنِ الرَّحِيْمِSchool Registration Form

Application form

Inspired Minds. Empowered Futures. www.theivyhouse.school
Pupil Details
Pupil Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityBorough or Town

Postal Code
Current Year Group
Nationality
Parent/Guardian 1 Details
Parent/Guardian 1 Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityBorough or Town

Postal / Zip Code
Relationship to Child
UK Phone Number
Please enter a valid phone number.Format: 00000000000.
Email Address
Do the parents share the same address?
Parent/Guardian 2 Details
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityBorough or Town

Postal / Zip Code
Relationship to Child
Email Address
UK Phone Number
Please enter a valid phone number.Format: 00000 000000.
Emergency Contact Information
Full name
UK Contact Number
Please enter a valid phone number.Format: 00000 000000.
Email
Academic Information
Current/Previous School Name
School Address

Street Address

Street Address Line 2
CityBorough or TownPostal / Zip Code
Previous Education Details
Previous School Name
Previous School Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous School Contact Number

Country CodeArea CodePhone Number
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional Details
Islamic Studies, Qur’an, and Arabic Proficiency

Qur’an Proficiency

Rows	Basic	Average	Good
Qur’an

Arabic Proficiency

Rows	Basic	Average	Good
Arabic

Medical Information
Does your child have any Medical conditions?
What is the medical condition?
Does your child suffer any Allergies?
Allergies details
SEND Needs
Does your child have any Special Educational Needs?
Does your child have an EHCP?
Consent and Declarations
Consent to School Policies and Data Use
Signature
Should be Empty:

Application form

Pupil Details

Parent/Guardian 1 Details

Parent/Guardian 2 Details

Emergency Contact Information

Academic Information

Previous Education Details

Islamic Studies, Qur’an, and Arabic Proficiency

Consent and Declarations