AFIC's MADRESSA 2018-2019 REGISTRATION
PARENT'S ARE REQUIRED TO FILL OUT A SEPARATE REGISTRATION FORM FOR EACH STUDENT SEPARATELY!!
NOTE:
Please fill out the information related to your CHILD down below:
First name *
Your answer
Last name *
Your answer
Birthday *
Your answer
Age *
Your answer
Gender *
Father's name *
Your answer
Mother's name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone #
Your answer
Cell Phone # *
Your answer
E-mail
Your answer
Emergency Contact For Health, Weather, and Updates With Madressa
The Madressa will call, text, and/or e-mail you to inform you about important information related to Madressa.
Name *
Your answer
Relationship *
Your answer
Phone # or Cell # *
Your answer
E-mail
Your answer
NOTE:
Please answer and place a check mark to the questions down below appropriately.
I understand that the fees of Madressa Fees are as follows: *
Required
I wish to receive information by one of the above forms of contact *
Required
Does your child have any allergies? *
If yes, please provide detailed information:
Your answer
List any medication(s) your child takes: *
Your answer
Liability and Responsibility
Please note that by signing your name down below, you are authorizing that in case of an emergency, we can seek appropriate medical treatment for your child.
Parent signature *
Your answer
Date: *
MM
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DD
/
YYYY
NOTE:
Parents play a vital role in the success of their child(ren)’s studies. To ensure that each child reaches his/her full potential, please review the following and place a check mark for understanding.
Keep your child’s attendance regular and on time. *
Required
Make sure your child has had a good breakfast and a proper nights sleep. Sleepy heads and hungry stomachs do not function well in class. *
Required
Pick up your child(ren) promptly after Salaah at 2:30 p.m. *
Required
Please inform the school of any planned absences. It is best to contact your child(ren)’s teacher, so that you can make note of what assignments will be missed. *
Required
Please make sure that your child is present for all tests. If for some unforeseen circumstance the child is not going to be present, please inform the teacher in advance. *
Required
Please review the following dress code and attendance policies and place a check mark for understanding *
Required
As parent/guardian of the student whose name appears above, I hereby release, waive, and sign my name below of any claim(s) against AFIC’s Madressa and its officers, directors, teachers, and volunteers for any damage or injury suffered by the students on account of or in connection with the student’s participation in school related activities. This Waiver and Release of Liability shall operate as a complete waiver and release for any personal injury, missing person, death and waiver of property or other damage or loss, including loss of use, which may arise in connection with the student’s participation in school related activity. I acknowledge that I am aware of the risks associated with the school related activities whether the risks are by reason of preparation for participation, transportation of the students, exposing the students to the elements and to general public, or otherwise exposing the students to risks which may or may not be generally associated with the school related activities. *
Your answer
I agree by signing my name down below to adhere to the dress code policy and other general policies of AFIC’s Madressa to the best of my abilities *
Your answer
I also agree by signing my name down below that I have read and understand all the information provided in the student/parent handbook and agree to abide by it, by the best of my ability. *
Your answer
Date: *
MM
/
DD
/
YYYY
Please write any concerns or requests you have down below.
Your answer
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