Youth Registration Form (ages 14+)
Registration is required in order to enroll for the upcoming 2017-2018 school year. Spots will be held for 1 week for attendees to allow time for payment to be made. All payments must be made in person (with cash or cheque) or online via e-transfer in order to guarantee a spot.

Fees are paid with a two-month structure, i.e upon registration, $80 is paid. This amounts to $40 for one month. There is also a $10 registration fee.

Student Information
Name *
Your answer
Gender *
Birth Date *
MM
/
DD
/
YYYY
Grade *
Your answer
School Name *
Your answer
Home Address *
Your answer
City *
Your answer
Province *
Your answer
Postal Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Health Information (If student is already a student @ Taleem, move to the next section. Please give copy of student immunization record to the office.)
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
Health Card Number *
Your answer
Any medical concerns? If yes, please give detail. *
Your answer
Family Information
Father's Name and Phone Number *
Your answer
Mother's Name and Phone Number *
Your answer
Any siblings enrolled in Taleem classes? If yes, please add their name and grade. *
Your answer
Emergency Contact Name (not living at same address) *
Your answer
Emergency Contact Phone Number *
Your answer
How did you hear about us? *
Your answer
Waivers
Photography - I agree to give Taleem permission to take pictures of my child while participating in the various programs and activities at the Taleem to be used solely for the purpose of advertisement and promotion in the future. *
I understand and agree that Taleem shall not be held responsible for any medical costs incurred in any situation. I understand that I am financially responsible for any medical costs incurred. I agree to release and not indemnify Taleem, its staff and volunteers from any injuries incurred to the applicant. Taleem reserves the right to cancel the registration if rules and policies of the school are not followed. *
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