Student Registration Form

Student Information

First Name:
Date of Birth:
Last Name:
Gender:
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Photography Exclusion

The School may take photo shoots on dates that will be announced, by default we request your consent to use photos that may include an image of your child on our publications. Please tick the box below if you DO NOT give us your consent to take photographs with your child included.

I DO NOT want my child to be included in School Photography.

Parent Information

Mother
Name:
Phone:
Email:
Father
Name:
Phone:
Email:

Address

Address Line 1*:
Address Line 2:
County:
City/Town*:
Postcode*:

Emergency Contact (Not Parents)

Full Name*:
Relationship to Child*:
Phone Number*:

Special Needs

Special Educational Needs:
Medical Conditions/Medication:
Allergies

Family at Yaqeen (Optional)

Family Member & Relationship
Family Member & Relationship
Family Member & Relationship

Confirmation

IMPORTANT:

 

Yaqeen Academy is a non-profit making organisation. Yaqeen Academy shall not be responsible for any loss or damage caused to any property whilst attending classes or other functions organised by it. Payment of fees must be made monthly or Termly regardless of attendance. Four weeks written notice is required if you/your child wishes to leave.

 

By signing this form:

  • you confirm that you acknowledge and agree to abide by Yaqeen Academy T&Cs, you can read them on a new tab here

  • the information you have provided is true,

  • you have read and agreed to the Home-School agreement.


Medical Treatment Consent: You give consent for your child(s) to receive any medical treatment that is urgently necessary.

Completed by:
Email of Submitter

I have read and agreed to the above statement