Hall Hire

Student Information

Please fill this form for student registration

Surname

Other Names

Gender
MaleFemale

Date of Birth

Place and Country of Birth

Nationality

Religion

Mother Tounge

Ethinicity

Father/guardian

Mother

Address

Post Code

Email Address

Parent/Guardian Occupation

Telephone (Home)

Telephone (Work)

Telephone (Emergency)

Mother’s Occupation (If working)

Telephone (Mother’s place of work)

Name of sibling in this school (if any)

Year

Last school attended

Please enclose Last School Report with the completed Application Form

Health (Serious illness, allergies)

Name of Family Doctor

Address and Telephone Number of Practice

I hereby apply for admission of my child to the school, and certify that all the above details are correct

Date

Signature Parent/Guardian

Full Name (Please Print)

Reach Out and Connect

CONNECTING FOR EXCELLENCE

Head Teacher

Arafat Hingora

Chair of Proprietor Body / Chair of Governing body

Hussein Suleman

Email

office@avicenna.school

Phone

0116 303 2644

Can be contacted at the correspondence address below

2 University Road, Leicester, LE1-7RA