Yameen Academy UK
Full Name Mother’s Name Date of Birth Address Mobile/Telephone Religion
Birth Name Father’s Name Birth Place Post Code Student’s National ID Nationality
Current School Name Current School Grade Previous Education Details
Current School Address Grade Passed Email or School Email Address
Name of GP (Doctor) Address of GP
Phone Number of GP
Does the student suffer from any of the following:
Asthma: YesNo Allergy: YesNo
Epilepsy: YesNo Any Others:
If yes, please specify: Is the student taking medication regularly? Any other relevant medical information:
Name of Parent/Guardian Additional Info (If not parent) Phone 1 Email Occupation Address of Workplace
Relationship Phone 2 Work Telephone Name of Workplace
Full Name Address Phone 1
Relationship Phone 2
Why would you like to enroll your child here? What would you like your child to achieve?
Please tick the documents submitted along with this form:
Birth CertificateProof of ID or PassportProof of AddressPassport PhotoMedical Report
Please read the rules and regulations carefully before submitting this application form. Misrepresentation or false information may result in rejection. Acceptance to the institution is based on eligibility, availability, and meeting our admission criteria.
I have read and agreed to the Rules and Regulations
I confirm that the information provided is true and complete. I accept the terms and conditions of admission and agree that failure to comply may result in disciplinary actions or cancellation of enrollment.
Parent/Guardian Signature Student Signature (if over 16)
Date Date
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