Islamic Early Childhood and Islamic Preschool (iECFE) Fall 2014 Registration Form
Semester dates: September 22nd - December 18th, 2014
For all registration information and policies, please visit:
Or call 612-888-4339

Please fill this form out for each child you wish to register.

New Enrollment? *
All new enrollments will be charged an additional $25 non-refundable registration fee in addition to semester tuition.
Childs Name *
First Name , Last Name
Your answer
Gender *
Date of Birth *
Your answer
Parents Name *
First Name, Last Name
Your answer
Cell / Work Phone Number (Best number to be reached at) *
Your answer
Home Phone Number *
Your answer
Email Address *
Your answer
Mailing Address *
Street name, City, Zipcode
Your answer
Class by Age Group *
Your child MUST be the appropriate age by September 1st, 2014. NO EXCEPTIONS.
Tuition Per Semester *
Please pick the fee based on the class and household income
Payment Method *
Please mail cash or check to: The Building Blocks/iECFE, 3900 Jackson St NE Columbia Heights, MN 55421
Please list any food or health allergies or concerns *
Your answer
Immunization records must be submitted to complete registration. Please submit these no later than the first day of class. *
You may ask your child’s pediatrician to fax the records to 1-866-481-9187
***Registration is not complete without payment*** *
Please mail cash or check to: THE BUILDING BLOCKS, 3900 JACKSON ST. NE COLUMBIA HEIGHTS, MN 55421
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