DUA Student Enrollment Form
Student Information
First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
DUA Program
Enrolled Program
Parent/Guardian Informaton
Parent/Guardian's Name
(First and Last)
Your answer
Relationship
Your answer
Address
Your answer
Phone
(Primary)
Your answer
Phone
(Alternate)
Your answer
Email
Your answer
Emergency Contact
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Authorized pick-up and drop-off person(s) contact Information:
Name
(Primary)
Your answer
Contact Phone
(Primary)
Your answer
Name
Alternate
Your answer
Contact Phone
(Alternate)
Your answer
Medical Information
Doctor Name
Your answer
Phone
Your answer
Clinic/Hospital Name
Your answer
Phone
Your answer
Allergies/Medical Problems:
Your answer
Medication
Your answer
Other Siblings Enrolled in DUA
Every student should have their own application. Other Sibling Information is for Tuition Discount Recognition Purposes Only
Student 1: Full Name
Your answer
Student 2: Full Name
Your answer
Student 3: Full Name
Your answer
Student 4: Full Name
Your answer
Student 5: Full Name
Your answer
Student 6: Full Name
Your answer
In case of an emergency, when the school is unable to locate a parent or a guardian, I authorize DUA personnel to resort to medical treatment for my child and to make whatever arrangements that deems necessary at the parent's cost.
Tuition Fees
Please refer to section under Hifz Programs for tuition fee details (http://darululoomaustin.org/hifz-programs/)
Financial assistance available for eligible students. If financial assistance is required, please send request to darululoomaustin@gmail.com. Approval of financial aid is required prior to enrollment.
Does the student require financial assistance?
Darul Uloom Austin Contact Information
Mailing Address: P.O. Box 80914 Austin TX 78708
Phone: (512) 956-6DUA or (512) 299-6947
Email: darululoomaustin@gmail.com
Web: www.DarulUloomAustin.org
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