EIC-WIS 2019-2020 Student Registration Form
EIC Weekend Islamic School is for children ages 6-12 years. It will be on Saturdays 11:15am-1:20pm from September 14, 2019 to April 18, 2020. Please submit this form for each child and pay the total EIC-WIS Tuition at https://www.eicsanjose.org/wp/eicwis (tuition: $300; sibling: $270; for new student, please add $50 registration fee). Please email us at eic-wis@eicsanjose.org if you have any questions.
Email address *
Student's Full Name *
Your answer
Gender *
Current Age *
EIC-WIS is for children ages 6-12 years. Please ensure that your child is within the age range on the first day of school [Sept. 14th, 2019].
Your answer
Birthdate *
format: mm/dd/yyyy
Your answer
Home Address *
format: street address, city, zip code
Your answer
Father's Full Name *
Your answer
Father's Email Address *
Your answer
Father's Mobile Number *
Please include area code
Your answer
Mother's Full Name *
Your answer
Mother's Email Address *
Your answer
Mother's Mobile Number *
Please include area code
Your answer
Does your child have any allergies or special needs that we should know about? *
If none, type "No". If yes, then please explain.
Your answer
Emergency Contact 1 *
format: full name & phone number [someone who is allowed to pick up your child in case both parents are unavailable]
Your answer
Emergency Contact 2 *
format: full name & phone number [someone who is allowed to pick up your child in case both parents are unavailable]
Your answer
Have you read the EIC-WIS Handbook? *
It is mandatory that you read the EIC-WIS Handbook before registering your child(ren)
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Your answer
A copy of your responses will be emailed to the address you provided.
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