The Lighthouse
Student Enrolment
1
Parent
2
Student
Step 1 of 2
Parent / Guardian Details
Please provide accurate contact and address information.
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Home Address
Address Line 1
*
City
*
Postcode
*
Relationship to Child
*
Aunt
Father
Grandparent
Guardian
Mother
Sibling
Uncle
Occupation
Additional Information
Second Parent Name
*
Second Parent Mobile Number
*
Second Parent Email Address
*
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Student
Remove
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Select
Male
Female
Address
Address
Postcode
Additional Details
Ethnicity Group
Select
Afghan
Bangladeshi
Chinese
Indian
Indonesian
Pakistani
Sri Lankan
Any other Asian background
African
Caribbean
Any other Black background
White and Asian
White and Black African
White and Black Caribbean
Any other mixed background
British
Irish
Any other White background
Arab
Kurdish
Any other ethnic group
Does your child require Special Educational Needs?
Yes
No
Please provide details about the SEN requirement
Does your child have any allergies?
Yes
No
Please provide details about the allergies
Additional Information
Emergency Contact Name
*
Relationship To Child
*
Full Address
*
Contact Number
*
Previous Madrasah Name And Address
*
Amount Completed At Previous Madrasah
*
Reason For Leaving Previous Madrasah
*
Current School
*
Site
*
Select Site
Masjid al-Ummah (Smethwick)
Zaytuna Community Masjid (Quinton)
Preferred Session
*
Select Preferred Session
Smethwick S1 (4.30 - 6pm)
Smethwick S2 (6:15 - 7.45pm)
Smethwick Hifz (4.45 - 7.45pm)
Quinton S1 (4.30 - 6pm)
Quinton S2 (6.15pm - 7.45pm)
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