Please enable JavaScript in your browser to complete this form.Weekend Islamic School - Registration FormSECTION A: Applicant's InformationName *FirstMiddleLastDate of Birth *Gender *MaleFemaleAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone *Phone - Residence *Email *SECTION B: Parent / Guardian InformationParent 1 *FirstLastRelationship *MotherFatherGuardianCell Phone *Parent 2FirstLastRelationshipMotherFatherGuardianCell PhoneSECTION C: Emergency Contact InformationName *FirstLastCell Phone *SECTION D: Medical InformationPlease list all medical conditions that may impact your study at AlManarat Academy or that may require attention while you are on campus. If there are none, please enter N/A *Health Card Number *Version Number *SECTION E: Fee Information Montlhy Fee (10 Months) Registration / Supply Payment Method $75 $100 Direct Deposit Direct Deposit Routing InformationBranch Number *Institution Number *Account Number *Financial Institution InformationName *Address *Address Line 1CityState / Province / RegionPostal CodePhone *Name(s) of Account Holder *Please Upload Void Check * Click or drag a file to this area to upload. SECTION F: Enrollment Agreement MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT : Personal information on this form is collected under the legal authority of the Education Act, R.S.O. 1980, c.129 and Health Card Numbers Control Act, 1991. This information will be used for the purposes of: processing student registration, production of student databases, student placement and referrals, statistical and reporting requirements by the Ministry of Education, program to students, contacting parent(s), guardian(s), etc., in case of emergency, and the disclosure of health related information to the Medical Officer of Health. Questions regarding this collection and use of personal information should be directed to the Administration Office. I take full responsibility to enroll my Child at Al Manarat AcademyI am financially responsible for his/her fees and expensesSignature *Clear SignatureDate *Submit