ICB Student Registration Form
Student Registration Form
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Parents\Guardians Name *
Adults students can put their own name
Address *
Please provide full address including State, City and ZIP Code
Email *
Home Phone
Mobile Phone *
Emergency Contact Name *
Emergency Contact Number *
Relationship to Student *
Student Name *
For Multiple Students Please add Name,DOB, Gender and Program to enroll manually here
Student Date of Birth *
MM
/
DD
/
YYYY
Gender *
Siblings Discount
We provide following siblings discount for weekday and Sunday School.

1. One child, 300 tuition fee and 50 books and registrations.
2. Two children, 550 tuition fee and 100 books and registration.
3. Three children, 600 tuition fee and 150 books and registration.
4. Four and above children 150/child tuition fee and 50/child books and registration.
Program to Enroll *
Required
Do student have any of the following *
Check all that apply
Required
Payment Plan *
If you cannot pay the student fee, please select Zakaat, We can arrange it by Zakaat collections on your behalf
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