Admission Application Form

Pupil Details

First Name(s)*

Surname*

Address*

Post Code*

Home Telephone*

UPN

Do you want to enter your child in our Hifz Programme?

Yes

Date of birth

Age on 1st September of current year

Current School Year*

Ethnicity

Upload photo

Family Details

Father

Father's Name*

Father's email

Father's Address

Father's Mobile*

Father's Occupation

Mother

Mother's Name

Mother's email

Mother's Address

Mother's Mobile*

Mother's Occupation

Marital Status

Married

Civil Partnership

Separated

Divorced

Sibling Information

Does your child have a sibling already studying at Jamiatul Ummah? If so please fill out the required details

Sibling Full Name

Sibling Year

Education

Primary School

Name of School*

Head Teacher/Principal

Address*

Local Authority Name

Post Code*

Primary School Telephone

Primary School email

Other schools attended

Please list all the schools your child has attended

Name of School 1

Year left School 1

Reason for Leaving School 1

Name of School 2

Year Left School 2

Reason for leaving School 2

Name of School 3

Year Left School 3

Reason for Leaving School 3

Secondary School

If your child is already in secondary school, please write the school's details here.

Sec. Name of School

Sec Current Year

Sec. Address

Sec Local Authority

Sec. Post Code

Sec. Telephone

Sec. email

Key Stage 2 Test Scores

Please enter expected test scores if SATS are unavailable

KS2 English

KS2 Maths

KS3 Progress Grades

KS3 level English

KS3 level Maths

KS3 level Science

SEN Needs

Does your child have SEN needs?

Yes

If so, do they have a statement?

Yes

Not applicable

Click here to upload a copy of the Statement

Medical Information

Doctor's First Name(s)

Doctor's Surname

Doctor's Address

Doctor's Post Code

Doctor's Telephone

Doctor's email

Does your child have any medical conditions which might affect his school life?

If so, please give us details

Is this child on a care plan?

If yes, please give us details.

Medical Condition details

Care Plan Details

Emergency Contacts

In case of emergency during school hours, we may need to contact someone in your absence. These persons should be someone we can contact easily during school hours.

Contact 1

Contact 1 Name*

Contact 1 Relationship*

Contact 1 Address*

Contact 1 Post Code*

Contact 1 Mobile*

Contact 2

Contact 2 Name*

Contact 2 Relationship*

Contact 2 Address

Contact 2 Postcode*

Contact 2 Mobile*

Additional Information & Signature

Payment of Fees

The following methods are available for the payment of fees. However, we recommend payment through monthly standing order

Please click the appropriate box

Fees*

1. Monthly, through standing order (Total 10 monthly payments)

2. Termly (Total of 3 termly payments)

3. At the beginning of the year (Total 1 payment)

How did you hear about Jamiatul Ummah School?

How did you hear?

Photo Permission

From time to time Jamiatul Ummah produces digital and and print material for marketing and promotional purposes. We may take photographs of your child for such material. Please tick this box if you do not want the school to use your child's photos.

I withold permission for photos

Yes

Confirmation

I confirm the information provided on this form is accurate to the best of my knowledge. I also confirm my commitment to payment of fees should my child be offered a place at the school, and I confirm my commitment to following and promoting the school’s ethos, values and policies.

Parent name*

Date*

Parent email*

Parent Signature*

Don't fill this field!