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
First Name : ___________________________ MI: ______ Last Name: ____________________________
Address: ___________________________________________________________ Apt # ________________
City: ________________________________ State: ______________ Zip: _________________________
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: ______________
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