Read & Rise Club Registration

Read & Rise Club

After School Qur'an Club

One booking form per family.

Registration form must be completed in FULL.

(Limited spaces) Places given after full payment on a first come first serve basis.

Parent/Guardian Details

Title

Surname *

Forenames *

Address *

Post Code *

Email *

Tel (Home/Work)

Mobile *

Occupation

Husband/Wife's Name

Husband/Wife's Mobile

Child's Name

Add up to 5 children to this registration.

Child 1

Forenames *

Surname *

Gender (M/F)

School

Year

D.O.B. *

Age

Emergency Contacts

Please give the names of two persons we may contact in case of an emergency.

Contact 1

Name *

Relationship *

Address

Post Code

Mobile Number *

Home Number

Work Number

Contact 2

Name *

Relationship *

Address

Post Code

Mobile Number *

Home Number

Work Number

Names of Collectors

Please give the names of persons who may/will be collecting your child/ren at 6:00 PM.

1st Person's Name

2nd Person's Name

3rd Person's Name

4th Person's Name

Payment Info & Policy

£480 per child, for the full academic year.
Once a child is registered in the Qur'an Club, fees must be paid in full, regardless of whether she/he attends all lessons or only a few lessons. The fee is NOT REFUNDABLE.

Please choose how you would like to pay the fees *

By CashBy Bank Transfer

Bank Transfer Details:

Bank: RBS

Account Name: Iron Aid Foundation

Account Number: 11157159

Sort Code: 16-33-45

Please use your child's name & date of birth as a reference.

Medical Information

Please provide all medical conditions, mental or physical. Also include allergies and any other conditions and requirements.

Please give any further information that you consider we may need

Declaration & Signature

By signing below, I confirm that the information provided in this registration form is accurate and complete. I understand and agree to the payment policy, and I authorise the persons listed as emergency contacts and collectors to act on my behalf as indicated.

Signature *

Please sign below using your mouse or finger (on touch devices).

Sign here

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info Reminder: Places are awarded on a first come first serve basis.

By submitting this form you are agreeing to our Data & Privacy Policy.