We will endeavour to provide a response within 3 days of receiving the message. Insha'Allah. Please fill in all required fields. Forename* (required) Surname* (required) Gender* (required) MaleFemale Father's Name* (required) Mother's Name* (required) Date of Birth* (required) Address Line 1* (required) Address Line 2 City/Town Postcode (required) Home Phone Number* (required) Email* (required) Father's Mobile* (required) Mother's Mobile* (required) Emergency Contact* (required) School* (required) Class Applied for* (required) Photographic Consent I give permission to the Birmingham Qur’an Academy to take photos and videos for publications, promotional purposes and for use on the website. I understand that my child’s name will not be given to press or public without my consent. I also understand that I may cancel this permission in writing and the Birmingham Qur’an Academy will take all reasonable steps to ensure that the photograph or film is withdrawn from future use. Medical Consent In the event of serious illness or accident, every effort will be made to contact the child’s parent or guardian. I understand that in an emergency, exigent circumstances may prevent the Birmingham Qur’an Academy from contacting me immediately. I therefore consent to the Academy taking action that deems necessary to secure emergency medical treatment for my child if I have not been contacted.
