Al Kauthar Girls Academy Online Application
Childs Name
Childs Address
Childs Date of Birth
Childs Home Phone Number
(1) Emergency Contact
(1) Relationship to Child
(1) Phone Number
(2) Emergency Contact
(2) Relationship to Child
(2) Phone Number
(1) Individuals Authorised to Collect Your Daughter
(2) Individuals Authorised to Collect Your Daughter
Name of Childs GP
GP Surgrey Address
GP Surgrey Phone Number
Does the child suffer from any serious or long term illnesses?
Does the child take regular medication?
Yes
No
Details of Childs Medication
Does the applicant suffer from any allergies?
Yes
No
Details of allergies
Does the child have any special educational needs? Please provide details
Has the applicant ever been involved with the police?
Yes
No
If yes, please provide details (Police involvement)
Has the applicant ever been involved with the Social Services?
Yes
No
If yes, please provide details (Social Services Involvement)
Which year group is your child currently in?
Select
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Name of most recent school attended
Address of most recent school attended
School Phone Number
Still Attending?
Yes
No
When did the child start at her current or last attended school?
Reason for leaving
Year 6 SATs Scaled Scores
Scaled Score
English
Grammar, Spelling, Punctuation
Maths
Parent/ Guardian 1 - Name
Parent/ Guardian 1 - Date of Birth
Parent/ Guardian 1 - Address
Parent/ Guardian 1 - Email
Parent/ Guardian 1 - Mobile Phone Number
Parent/ Guardian 1 - Home Phone Number
Parent/ Guardian 1 - Occupation
Parent/ Guardian 1 - Work Phone Number
Parent/ Guardian 2 - Name
Parent/ Guardian 2 - Date of Birth
Parent/ Guardian 2 - Address
Parent/ Guardian 2 - Mobile Phone Number
Parent/ Guardian 2 - Home Phone Number
Parent/ Guardian 2 - Email
Parent/ Guardian 2 - Occupation
Parent/ Guardian 2 - Work Phone Number
Terms & Condition
By filling this form, you agree to our
Terms and Conditions
Next
Submit
Previous
Page
1
of
6
Form service by Formlets.com
