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NIC Weekend Islamic School for Students 4-12 Years Old
Registration Form
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Birth Date
MM
/
DD
/
YYYY
Age
Your answer
Gender
*
female
male
Grade
*
KDG
1
2
3
4
5
6
7
Father Name
*
Your answer
Mother Name
Your answer
Contact 1
*
Your answer
Contact 2
Your answer
Check all that apply
Heart problems
Physical restrictions
diet restrictions
seizures
handicap
allergies
diabetes
other, illness, disability, special needs medication
Your answer
I agree to abide by all rules and regulations regarding tuition fees, dress code, code of conduct, pick up and drop off etc. as mentioned in the Parent/Student Policy Handbook?
*
Yes
No
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