Waiting List Form

Waiting List Form for children aged 2 - 16 yrs - Parent/Guardian to complete.

Student Information

Full Name:

Date of Birth:

Gender:

Preferred Start (Academic Year)

Parent/Guardian Information

Name:

Phone:

Email:

Address

Address Line 1*:

Address Line 2:

County:

City/Town*:

Postcode*:

Family at Yaqeen (Optional)

Names of all Family Members

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 IN ADVANCE 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
the information you have provided is true,
you have read and agreed to the Home-School agreement.

Completed by:

Reference

I have read and agreed to the above statement

YAQEEN ACADEMY

Inspiring Islamic Education