Ashton Central Mosque Registration

Address, Postcode and password are not required, you do not need to fill them in

* denotes required field

*Your first name:

*Surname:

*Your email:

*Confirm email:

Date of Birth:

*Gender:

Portal Password:

Confirm password:

If you already have an account and a password, you can skip this and leave it blank. Otherwise you should set your password now to create your password.

Telephone:

*Mobile:

Address: Postcode:

Application Group:

*Enroll:

Mental Health Course 2025 3 week course

Add medical info/notes

Contacts

You are the primary contact of yourself as the student. You can add additional contacts such as Husband/Wife, Father, Brother etc. as primary contacts or emergency contacts.

Additional Contact #1

*Contact Name:

Email:

Tel.:

Parent Portal Password:

Confirm:

Mobile:

Alt. Mob.:

Relation:

Type:

Primary Contact? This means the contact will receive emails concerning you such as fees reminders, receipts, end of year reports etc. The contact will also see your data on the parent portal to view progress and other information. If you select no here, this contact will not see you on the parent portal.

I consent that IBEUK can process this form and submit directly to Ashton Central Mosque. Your data will not be stored nor used by us.

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