Al-Rashid 2021 -2022 Returning Students Registration Form
بسم الله الرحمن الرحيم
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Email *
I UNDERSTAND I WILL BE CONTACTED ONLY IF A SPOT IS AVAILABLE. *
Required
I UNDERSTAND THAT THIS APPLICATION IS ONLY FOR STUDENTS WHO HAVE STUDIED AT AL-RASHID IN 2018, 2019, 2020 OR 2021. Please select the most recent year you were enrolled. *
2018
2019
2020
2021
Most recent year at Al-Rashid
Student First Name *
Student Last Name *
FATHER’S / GUARDIAN’S NAME (FIRST AND LAST) *
MOTHER’S / GUARDIAN’S NAME (FIRST AND LAST) *
STREET NUMBER *
STREET NAME *
APT/UNIT
CITY *
PROVINCE / STATE *
POSTAL / ZIP CODE *
DATE OF BIRTH *
MM
/
DD
/
YYYY
GENDER *
PHONE NUMBER *
FATHERS/GUARDIANS EMAIL *
MOTHERS/GUARDIANS EMAIL
Which program will you be enrolling in? ( Male Students)
Clear selection
What grade were you enrolled in at Al-Rashid during 2020-2021? *
Have you or anyone in your household tested positive for COVID-19 *
If you or anyone in your household tested positive for COVID-19, please provide approximate date.
Have you received the COVID-19 Vaccine? *
If you have not received the vaccine, would you still be interested in admission if the vaccine was a requirement for admission? ( Age 12 and above)
Clear selection
Does the applicant have a criminal record or pending criminal charges? *
Please notify us of any medical condition(s). If there are no medical condition(s), please write "none". *
RULES, REGULATIONS, AND POLICIES
1. The Student will be required to follow the sacred Shariah and Sunnah of the Holy Prophet Muhammad (sallallaho-alaihiwasallam) in all aspects of life at the Institute.

2. The student must practice acceptable manners of politeness and social behavior towards fellow-students, faculty, and staff of the Institute.

3. The student must have regard for the general cleanliness of the property and his dormitory.

4. The student will be permitted to leave the Institute only during vacations as determined by the Institute. The Principal may
grant special leave when deemed necessary upon written request from a parent/guardian. The student must attend all classes and activities of the Institute unless permission is obtained from the principal.

5. The student is not permitted to own or use any small or major appliances, (Ex. toaster, fridge, microwave, deep fryer, etc.)
media/entertainment devices, (Ex. video game devices, cell phones, audio, and video devices, etc.) or fitness equipment. (Ex.
exercise bike, bench press equipment, etc.) If any of the fore-mentioned property is found, it will be confiscated and may be
returned at the sole discretion of the principal. The data on any electronic devices may be subject to inspection; a student
forfeits any privacy by possessing any electronic devices without prior permission. Under special circumstances, students may
obtain explicit permission from the principal to own or use certain property.

6. All costs incurred as a result of the damaged Institute property caused by the student will be paid by the student/parent/guardian.

7. Al-Rashid is not responsible for any injury sustained by a student. The student is responsible for any medical or dental costs
incurred. The damage or theft of personal property is also the sole responsibility of the student.

8. The student or parent/guardian must disclose any physical or mental disorders of the student before enrolling in the Institute.

9. The student or parent/guardian must disclose any history of involvement with the police or the judicial system.

10. Certain areas of the Institute are monitored by security cameras for the purpose of safety, prevention of criminal activity, and
enforcement of the Institute’s rules and regulations. Any evidence collected thereby will be used in the investigation and
prosecution of any criminal activity.

11. All new applicants may be subjected to a personal interview with the principal. Students may also be subjected to an admission test in religious and secular school subjects.

12. The annual fee may be revised at the discretion of the Institute.

13. The student/parent/guardian agrees not to pursue any legal recourse should the student be subjected to correctional measures, including but not limited to detentions, suspensions, or expulsions.

14. Violation of any rules or regulations may be deemed sufficient for expulsion from the Institute at the principal’s discretion
I certify that all statements on this application are correct and complete. I understand that my admission or registration is subject to cancellation at the sole discretion of the Institute. I agree with the rules, regulations, and policies listed above , as well as any additional requirements that may be imposed by the Institute. I understand that this application does not guarantee enrollment. I authorize the Institute to act as a legal guardian and make any decisions, including medical decisions on my behalf. *
eSignature of Student ( If the student is over 18)
Please sign with your full name
Date of Student signature
MM
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DD
/
YYYY
eSignature of Parent / Gaurdian (if student is under the age of 18)
Please sign with your full name
Date of Parent / Guardian signature
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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