Imam Motala Academy

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Admission

Weekday or Weekend Option

Hifdh Class (Tuesday – Friday)
Hifdh Class (Tuesday – Friday)
Online: Wed to Fri (5 PM – 6:30 PM)

Student's Name

First

Last

Date of Birth

10-1-2018

Weekend is your

Age

Nationality

Child Health Is there a disability / allergy / serious condition / learning difficulty which we need to know? You must provide this information for us to help your child progress. Please give FULL details. If NONE then please state NONE

Nursery/School, Name & Year *Please state which nursery / school your child attends and which year they are in:

Level Of Study

Quran
Ahsanul Qawaid
Juz Amma

Previous Madrasah

SECTION 2 (Parental Information) Please fill in this section as accurately as possible, this is integral to the application.

Parent 1

This is the parent who will be contacted for the application process.

Full Name

Address

Relationship To Child

Father
Mother
Other

Contact number

Emergency Contact

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