Census - Al Quaim

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1. Household Information

Number of people in your household (Including you)

Number of Children (under 16) in your household

Child 1 Age

Child 2 Age

Child 3 Age

Child 4 Age

Child 5 Age

Child 6 Age

Name of Head of household

2. Contact Information

Email Address

Phone Number

Do you live in Slough (or withing 5 miles)

Yes No

Do you contribute monthly to Al Quaim by DD or standing order

Yes No

3. Additional Information (Optional)

Special Health Needs

Yes No

If Yes then Provide Details

Additional Information (any suggestion/requirements)

I have read and agree to Privacy Policy.

Note: If you would like to join WhatsApp communication group or volunteer for the mission, please contact a committee member.

Please fill in the form below to send an enquiry.

Al Quaim Islamic Mission, 39 Montrose Avenue, Slough, Berkshire SL1 4TN

Al Quaim Islamic Mission, 39 Montrose Avenue,
Slough, Berkshire SL1 4TN