Little Muslim Academy Registration & Consent Form
Standard online registration and consent form for Little Muslim Academy. Complete all required details, consents, and declaration fields.
Child Information
Child’s Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Gender
*
Please Select
Male
Female
School Attending
Year Group
Home Address
*
Postcode
*
Parent / Guardian 1 Details
Parent / Guardian 1 Full Name
*
First Name
Last Name
Relationship to Child
*
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Home Address (if different)
Occupation
Parent / Guardian 2 Details
Parent / Guardian 2 Full Name
*
First Name
Middle Name
Last Name
Relationship to Child
*
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Home Address (if different)
Occupation
Emergency and Collection Details
Emergency contact name
*
Relationship to child
*
Telephone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Who is authorised to collect the child?
*
Collection arrangements telephone number(s)
Medical Information
Medical conditions
*
Please Select
No
Yes
Medical conditions details
Allergies
*
Please Select
No
Yes
Allergy details
Carries medication
*
Please Select
No
Yes
Medication details
Anything else we should know about the child
Photograph, Video, and Consent Statements
Permission for Photograph and Video Consent
*
Please Select
Yes
No
Class Photographs Consent
*
Please Select
Yes
No
Academy Displays Consent
*
Please Select
Yes
No
Website Consent
*
Please Select
Yes
No
Social Media Consent
*
Please Select
Yes
No
Promotional Materials Consent
*
Please Select
Yes
No
First Aid Consent
*
Please Select
Yes
No
Parental Responsibilities
*
I agree to the parental responsibilities listed above
General Consent Statements
*
I confirm the information provided is true and accurate
I understand my child is enrolled at Little Muslim Academy
I understand reasonable care will be taken to ensure my child’s safety while attending classes
I agree to my child’s information being stored securely and used for administration and safeguarding purposes
Data Protection (UK GDPR) Acknowledgement
*
I have read and understood the data protection statement
Parent / Guardian Declaration
Parent / Guardian Declaration Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes
Submit
Submit
Should be Empty: