Ikhlas Academy Registration Form 2019-2020
Dear Parents, please be prepared to pay on September 15th in person. Cash and checks are accepted.
Fees: $100 / year / child. Scholarships available for zakat eligible families.

Ikhlas Academy hours: 11:30am - 1:30pm

Please submit a separate form for each student. You will be given an option at the end to submit another form.
Email Address *
Your answer
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
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/
DD
/
YYYY
Student's Age *
Your answer
Name of School Attending
Your answer
Current Grade Attending
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Primary Phone Number *
Your answer
Emergency Contact Number *
Your answer
Allergies
Your answer
Any additional information about the student?
Your answer
Submit
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