Enrol Now

FAIZAN E ISLAM ACADEMY ADMISSION FORM
(subject to terms and conditions attached)
PLEASE COMPLETE FORM USING CAPITALS ONLY
PART A: STUDENTS’ DETAILS
Name of Student 1
Male/Female: Date of Birth: School Year:
Start Date:
PART B: PARENT / GUARDIAN / EMERGENCY DETAILS
Name of Parent / Guardian 1:
Relationship to student:
Address of Parent / Guardian 1:
Mobile No. of Parent / Guardian 1:
Email address of Parent / Guardian 1:
Name of Parent / Guardian 2:
Relationship to student:
Address of Parent / Guardian 2:
Mobile No. of Parent / Guardian 2:
Email address of Parent / Guardian 2:
Name of Emergency Contact:
Relationship to student:
Address of Emergency Contact:
Mobile No. of Emergency Contact:
Email address of Emergency Contact:
PART C: MEDICAL CONDITIONS
TO BE COMPLETED BY PARENT/GUARDIAN
Name of Student 1
Male/Female: Date of Birth:
Does your child have any disabilities or medical conditions? Yes No
If YES, please specify:
Does your child take any medication? Yes No
If YES, please specify:
Does your child have any allergies? Yes No
If YES, please specify:
Does your child have a special diet? Yes No
If YES, please specify:
Any other information we should know about:
Name of GP:
Address of GP:
Tel No. of GP:
Name of Parent/Guardian:

Signed: Date: