Arabic Program Islamic Studies Program Both (Arabic & Islamic Studies Program)

Saturday School Registration Form 2013-2014

First M/F Age

Recurring Student New Student Previous school attended (if any):

Student Name(s):
Last 1st Child: 2nd Child: 3rd Child: 4th Child: Home Address: Home Phone Number: ( ) City: DoB / / / / / / / / Grade

Zip Code:

Parents / Guardians:
Mothers Name: Fathers Name: Cell Phone ( Cell Phone ( ) ) Email: Email:

Emergency Contact Information

Name: Relation to Child: Phone: ( ) -

Please Read & Sign

I, , understand that the tuition is non-refundable, regardless of whether or not my child(ren) completes the school session. I understand that if my child is not fully cooperating with the school rules or is endangering other of school property, then administration will be in contact with the family, and consequences will occur. I also understand that the school is not responsible for any injuries that may occur at the school.

Guardian Signature:
Office Use Only: Admitted Contract Paid (1st Semester) Paid (2nd Semester) Student intl.1. 2. 3. 4. Class no. Class no. Class no. Class no. Fee/sem Fee/sem Fee/sem Fee/sem

Date:
Total Paid (1): Payment method: Total Paid (2): Payment method:

Office Signature: ______________________________

Date: __________________