Winter Retreat Register - Al-Manarat Academy

Winter ‘Ilm Nourishment Retreat

Registration Form

Dec 27 – 29 | 11AM – 7PM

Registration Form

Section A: Applicant’s Information

How many family members are enrolling?*

First Name*

Date of Birth*

Last Name*

Gender*

2nd Family Member Information

First Name (2nd Family Member)*

Date of Birth (2nd Member)*

Last Name (2nd Member)*

Gender (2nd Member)*

3rd Family Member Information

First Name (3rd Member)*

Date of Birth (3rd Member)*

Last Name (3rd Member)*

Gender (3rd Member)*

4th Family Member Information

First Name (4th Member)*

Date of Birth (4th Member)*

Last Name (4th Member)*

Gender (4th Member)*

5th Family Member Information

First Name (5th Member)*

Date of Birth (5th Member)*

Last Name (5th Member)*

Gender (5th Member)*

6th Family Member Information

First Name (6th Member)*

Date of Birth (6th Member)*

Last Name (6th Member)*

Gender (6th Member)*

7th Family Member Information

First Name (7th Member)*

Date of Birth (7th Member)*

Last Name (7th Member)*

Gender (7th Member)*

Section B: Contact Information

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Primary Phone Number*

Secondary Phone Number

Email Address*

Section C: Parent's/Guardian's Information

Parent 1

First Name

Last Name

Relationship

Father

Mother

Guardian

Cell Phone

Parent 2

First Name

Last Name

Relationship

Father

Mother

Guardian

Cell Phone

Section D: Fee Information

Fee: $75 for 3 Days
$50 additional for each sibling
You will be required to email money transfer the total fee amount to info@almanaratacademy.com after submitting the registration form to confirm your spot.

Section E: Enrolment Agreement

Declaration*

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

APPLICANT'S / PARENT'S / GUARDIAN'S SIGNATURE*

Date*

This field should be left blank