Malik Academy & Blackstone – Parent Interest Form for Upcoming Programs

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Dear Families,

Our team continues to work tirelessly on building an exciting new chapter for our school. As part of this effort, we are designing a variety of enriching programs that we plan to offer at our new home.

This quick form will help us better understand which types of programs you and your child would be most interested in, so we can shape our offerings to meet the needs of our community.

Thank you for your input and continued support!

Parent(s) Name(s)

Contact Information: Phone Number and Email Address

Child(ren)'s Name(s) and DOB

Grade Level or Age Group for 2025-2026 school year

Toddlers (Age 1.3+)

Pre-K (Ages 3–4)

Kindergarten

1st Grade

2nd Grade

3rd Grade

Other:

Clear selection

Program you are interested in (check more than one options)

Full time School in Cambridge (Al Bustan)

Full time School in Roxbury (Blackstone)

Weekend School K-12 (Islamic Studies) Roxbury only

Afterschool Program

Quranic Hifz Program Roxbury only

Youth Group Middle and High School

Other:

Please share ideas for services or resources you suggest for future offerings.

Submit

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