WEST LONDON ISLAMIC CENTRE

WEST LONDON ISLAMIC CENTRE

GREENFORD XXXXXX ISLAMIC SCHOOL

Allied Sainif House, 000 Xxxxxxxxx Xxxx, Xxxxxxxxx, Xxxxxxxxx, XX0 0XX

                Telephone Number: 000 0000 0000 Email: xxxx@xxxxxxxxxxxxxxxxxxx.xxx        

Application Form

Student’s Details:

Surname: ………………...………………....... First Name: ………………………………........................................................................

Address: ………………………………………………………………………………………...................................................................................

Postcode………………...................... Date of Birth ………………….................................... Male/ Female………………………....

Preferred Days Weekends (Sat & Sun) Weekdays (Mon to Wed)

Father: ……………………………………....................................... Telephone No: …………………………………….............................

Mother: …………………………………......................................... Telephone No: ……………………………………............................

Emergency Contact Details:

Name ………………………................. …............... Relationship……………........... Telephone No: …..………………........................

X.X.Xxxx: ............................................................................ Telephone No: ...................................................................

Address: ..............................................................................................................................................................................

Postcode: ................................. Medical Conditions/ Special Requirements: ...................................................................

ADMISSION FEES: £5.00

FEES: £5.00 per week.

TIME: Saturday and Sunday from 10.30 am to 12.30 pm

Monday to Wednesday from 5.00pm to 6.30pm

METHOD OF PAYMENT MOMTHLY: (Payment must be made first weekend of every month- NO REFUNDS will

be made for missed classes. We highly appreciate your co-operation and prompt payment every month)

Agreement:

I undersigned hereby apply for admission of the above named child and agree to abide by the rules and regulations of the School.

I agree to hold myself responsible for any damages that may be caused by the child named above.

I understand that any injuries caused to the above named child; during the attendance at, to and from the School are not entitled to any claims or damages against the School.

Name: ............................................................. Signature: .................................... Date: .............................................

Office Use:

Officer Name: ...........................................Signature: .......................... Date of application: .................................

Charity Commission Registration Number 290990