Masjid An-Noor

1300 Fairfield Ave, Bridgeport, CT 06605

  Registration Form 2016-2017 / 1437 - 1438  A.H.

 New and Returning Students MUST complete this Registration Form

 

  Registration Fee:  Per Child $25

Student Information

First Name :  ___________________________           MI:   ______       Last Name:  ____________________________        

Address:   ___________________________________________________________         Apt #   ________________

City:  ________________________________         State:    ______________             Zip:  _________________________

Sex: _____Female    _____Male        Date of Birth:  _____________________      Age : ______ Grade:  ______                                            

Primary Language: ________________________         Other Language(s):  _____________________________________

Father's Name: ______________________________________________________________________________________

Mother's Name:  _____________________________________________________________________________________

Email Id:   ________________________________________________________________________________________

Home Phone: _______________________________      Email:  ___________________________________________

Father's Cell#: __________________    Mother's Cell#:  _________________________________________

Father's Work#:  ______________________________  Mother's Work#:    __________________________________

Emergency Contact: _______________________  Phone#  ___________________________   Relation: ______________

Any medical condition:   _____NO       _____YES      Doctor's Name/Phone #____________________________

Timing: (Fri@5:30::7pm and Sat-Sun@9:30-12:30pm)

Tuition Fee: Due 7th of every month.   Late Charge: $10 per month after 2 weeks of grace period

1 Child - $ 30                                                             2 Children -   $ 60  

3 Children - $ 80                                                       4 or more Children - $ 100

Cost of Books : Varies per grade level

Code of Conduct

Dress code: Please send your kids in clean and modest attire in accordance with Islamic dress code.

Boys: Thobe (one piece long dress), Shalwar-Kameez (2 piece dress), Pants and shirts or t-shirts (with no picture of human or animal) are acceptable. Dress with vulgar inscription and pictures are not acceptable. No shorts at all. No jewelry except for wrist watch.

Girls: Thobe (one piece long dress), Shalwar-Kameez (2 piece dress), Pants and full sleeve shirts or loose long t-shirts (with no picture of human or animal) are acceptable. Dress with vulgar inscription and pictures are not acceptable. All girls must come with headcover known as hijab. For older girls wearing Abaya is recommended.

Attendance: All students are required to attend at least one fundamentals of Islam session a week (Saturday or Sunday). Student has to inform us before or after with parent’s note for missed sessions with a valid excuse. If going on a holiday or vacation, please inform us ahead of time. In case you don’t inform for vacation, you have to re register your kids with fee payment. Parents/guardians are responsible for picking their kids on time after the end of sessions.

Discipline: Students are required to abide by all rules of Masjid An-Noor education program while attending any sessions. Students have to listen and respect all the teachers and support staff. Disobedient students will be disciplined in accordance with norms and federal and state regulations.

Emergency:  I hereby authorize the Masjid An-Noor Evening Islamic School to take my child to a medical center in the event of emergency in case neither parent / emergency contact can be reached. All the medical bills including Emergency Room, Doctors, Medicines, & Ambulatory Services etc. are the responsibility of the Parents/Guardians. Masjid An-Noor Evening Islamic School or the Masjid is NOT RESPONSIBLE for any occurring medical bills.

I agree to pay the tuition fee, registration fee, half tuition fee of June 2014 and the cost of the books on the day of registration and on the due dates promptly.

I, _____ have read and understood the code of conduct of Masjid An-Noor Evening Education program and pledge to abide by it.

Parent / Guardian Signature:   _______________________________________          Date: _______________________ 

Disclaimer: Masjid An-Noor Educational Program is not responsible for students outside the sessions and any mishaps during the sessions and any accidents or injuries that may occur due to non-compliance of the students.

Office Use Only

Number of children :    _____________________________

Paid by  Cash: $ _____________      Balance: $ ___________________

Received by :  _____________________________________

Contacts: Amjad 203-722-9849