Masjid Al Hikmah I'tikaf Application Form

Masjid Al Hikmah I'tikaf Application form
Please fill in the details correctly to the best of your knowledge. The mosque reserves the right to reject any application based on incomplete data.

The data collected in this form will only be used for the purpose of processing your i'tikaf application, and kept on record during your stay for your safety and wellbeing.
Name*

First NameLast Name
Your Details
Address*

Street Address

City

Post Code
Phone Number

Area CodePhone Number
E-mail*
Age*
Gender*

MaleFemale
Form of ID *
Other (Specify)
If you have any medical conditions which may impact your I'ktikaf in any way please give details below:*
Any other comments
Emergency Contact Details
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Doctor's Name
Doctor's Phone Number

Area CodePhone Number
Declaration
The Masjid offers a facility for special overnight stays meant exclusively for worship purposes.

Please note that this service is only available to Brothers and Sisters who are 16 years old and above.

It is important to remember that the charity reserves the right to refuse permission for an overnight stay at the Masjid. In addition, the continued use of the Masjid for I’tikaf is subject to following the Masjid Usage Policy FAC-01.

Please be aware that permission can be revoked at any time if it is found to violate this policy or due to the trustees' decision.
Should be Empty:

Masjid Al Hikmah I'tikaf Application form