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Childs Detail
Class
*
Madrasah Boys Class
Madrasah Girls Class
First Name
*
Surname
*
Date of Birth
*
Gender
*
Ethnicity
*
Address
*
Parent/Guardian's Details
Full Name
*
Address
*
Post Code
*
Mobile No
*
Email Address
*
Emergency Contact
Full Name
*
Mobile No
*
Relationship to Child
*
Declaration
I confirm that the information provided is correct to the best of my knowledge.
*
Date
*
Submit Application