Weekend Islamic School Registration Form - Al Manarat Weekend Islamic School

Weekend Islamic School - Registration Form

SECTION A: Applicant's Information

Name *

First

Middle

Last

Date of Birth *

Gender *

Male
Female

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Cell Phone *

Phone - Residence *

Email *

SECTION B: Parent / Guardian Information

Parent 1 *

First

Last

Relationship *

Mother
Father
Guardian

Cell Phone *

Parent 2

First

Last

Relationship

Mother
Father
Guardian

Cell Phone

SECTION C: Emergency Contact Information

Name *

First

Last

Cell Phone *

SECTION D: Medical Information

Please 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
$50	$100	Direct Deposit

Direct Deposit Routing Information

Branch Number *

Institution Number *

Account Number *

Financial Institution Information

Name *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Phone *

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 Academy

I am financially responsible for his/her fees and expenses

Signature *

Date *