S I Madressa

New Admission

Student - Personal Details

Student - Contact Details

Additional Details

Parent/Guardian 1 - Personal Details

Parent/Guardian 1 - Contact Details

Parent/Guardian 2 - Personal Details

Parent/Guardian 2 - Contact Details

Madressa Photo & Video Policy Consent

Policy Agreement

Please ensure that you have fully read our admission policy and also viewed our FAQs before you complete this form. You can find both of these items here : https://madressa.net/admissions/

Fields with*are required.

Address Line 1 *	Address Line 2	City *


County	Postcode *	Email *


Home Tel No *	Phone 2

School Name *


Does your child have any Special Education Needs [SEN] or receive any Educational Support currently in school ? Yes No

Please provide details relating to SEN or additional learning support provided to your child * Please provide details of statements as assessed by the child’s school. This information will be dealt with confidentially by the Madressa and passed on to our Learning Support team who will be in touch

General Notes

Medical Notes Please list any allergies, medical conditions, medications etc

First Name *	Last Name *	Relation *


KSIMC Membership Number *	Do you work with children? *	Occupation
? If you do not have a membership number please leave 0000 in this box	Yes No

Are you a school governor? *	If yes, please provide the name of the school*
Yes No

Email *	Alternate Phone 1 *	Alternate Phone 2
	This number will be emergency contact number which could be a relative or friend

Mobile Phone *	Alternate Address Line 1	Alternate Address Line 2


City	County	Postcode

First Name *	Last Name *	Relation *


KSIMC Membership Number *	Do you work with children? *	Occupation
? If you do not have a membership number please leave 0000 in this box	Yes No

Are you a school governor? *	If yes, please provide the name of the school*
Yes No

Email *	Alternate Phone 1 * This number will be emergency contact number which could be a relative or friend	Alternate Phone 2


Mobile Phone *	Alternate Address Line 1	Alternate Address Line 2


City	County	Postcode

The Madressa has a 'Use of Images' policy in line with its Safeguarding commitments in order to provide a greater understanding on how images will be handled and what boundaries are in place for Madressa events

This policy will govern how the Madressa will handle matters relating to photography and video on the Madressa premises.

Occasionally, we may take photographs of the children at our Madressa. These images may be used in our Madressa printed publications that we produce, on our website, or on project display boards. We may also make video recordings for monitoring or other educational use.

To review our full policy, please click here

May we use your child’s photograph in printed publications that we produce for promotional purposes, or on project display boards, etc? *	May we use your child’s image on our Madressa Website? *
Yes No	Yes No

May we use child's image on video? *	May we allow your child to appear in the media as part of our Madressa's involvement in an event? *
Yes No	Yes No

By clicking ‘Register’ you also agree to our :

Admission and Attendance policies
Privacy notice which outlines how we will use the data you have provided to us for Madressa purposes only
All other policies that are either posted on our website www.madressa.net, provided in writing or communicated through other means.
If my child is aged 13 or over, I have consulted him / her on how the Madressa will utilise their data and they have provided consent for Madressa to use their data

First Name *

Middle Name

Last Name *

Date Of Birth *

?
Your child must have reached the age of 4 prior to 1 September to be eligible to join Madressa.