Swansea Mosque Academy - Withdrawal Form

Swansea Mosque Academy

Student Withdrawal
We are sorry to see your child leave. Kindly give us reason for withdrawal and feedback for the time spent at the Academy.
Student Name - As it is on our Systems

First NameLast Name
Student ID:
Reason For Withdrawal
Section
Leaving Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearToday or Future Date Only
Review of Nursery/Madrasah/Hifz
Main Parent Name

NameLast Name (Family Name)
Main Parent Mobile Number
Please enter a valid phone number.Format: 00000 000000.
Main Parent Email
Please Use Same Email As Used for Payments
Signature
Should be Empty: