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Weekend Islamic School - Student Application 2019-2020
Email address *
Student Full Name *
Your answer
Date of Birth *
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Gender *
Grade Level *
Returning Student *
Father/Guardian Full Name *
Your answer
Father/Guardian Phone Number *
Your answer
Father/Guardian Email *
Your answer
Mother/Guardian Full Name *
Your answer
Mother/Guardian Phone Number *
Your answer
Mother/Guardian Email *
Your answer
Emergency Contact Full Name *
Your answer
Emergency Contact Relationship to Child *
Your answer
Emergency Contact Phone Number *
Your answer
Are you a teacher in the WIS School? *
How many children do you have attending the Weekend Islamic School. *
Please select student fees according to total number of children attending. *
Please include any medical conditions, allergies or special needs we need to know about your child:
Your answer
Please print your name and the date below to accept this agreement: I certify that I am the parent or legal guardian of the child listed above. I also authorize the Islamic Center of Virginia/Weekend Islamic Center (WIS) to obtain through a qualified person, physician or hospital such medical care as necessary for the welfare of my child in case of any injury or sickness during the school hours. I hereby waive my rights or claims against the School, teachers, administration, executive committee, board of trustees, and/or volunteers. *
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Print Name: *
Your answer
A copy of your responses will be emailed to the address you provided.
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