Yameen Academy UK
Choose the Program Weekday MadrasahWeekend MadrasahTeen Essential Alimiyyah
Choose the Session Mon–Tue (Weekdays)Wed–Fri (Weekdays)Morning (Weekend)Afternoon (Weekend)
Category of the Student ContinuingReturneeNew
Full Name
DOB
Home Address
Gender MaleFemale
Post Code
Current/Previous Madrasah Name
Reason for Leaving
Current School Name
Current School Address
Current School Year
What is the student reading now? StarterQaidahJuz ‘AmmaQuran
How many Soorahs memorised?
How many Duas memorised?
Islamic Studies Book NoneNaseehaSafarOther
Book Series No
Sibling in Yameen Academy? YesNo
If Yes, Name
Father’s Name
Contact No
Email Address
Mother’s Name
Father/Mother/Guardian FatherMotherGuardian
Name
Relation (in case of Guardian)
Mobile
Email
Relation
Contact No 1 Contact No 2
Does the student suffer from any of the following?
Asthma YesNo
Allergy YesNo
Epilepsy YesNo
Any other health issue
Does the student take any regular medication? YesNo
If yes, please specify
Any other medical info
Does the student have any of the following? Autism Spectrum Disorder (ASD)ADHD (Attention Deficit Hyperactivity Disorder)None above
Does the student have any other learning difficulty issue? YesNo
If yes, specify
Who will drop off and pick up the student? They will go on their ownParent/GuardianOther
If Other, Name
Phone Number
I have read and I hereby agree to abide by Yameen Academy’s Policies, Terms & Conditions.
Guardian Signature
Date
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