Student Registration Form
  • This Form is for children and adult learners
  • This form do not confirm registration, until payment is received
  • After completing this form, an email with our terms and conditions will follow 
  • Kids classes are for those born between 2012 & 2019
  • Adult classes are for 14 + sisters
Sign in to Google to save your progress. Learn more
New Student *
Student Personal Information:
First Name *
Last Name *
Other Name
Date of Birth (for adults: put today's date) *
dd/mm/yyyy (e.g. for Apr 5, 2001 you enter 05/04/2001) 
Gender *
Grade/Level *
Parent/Guardian(s) information:
Father/Guardian First Name (for adults: put N/A) *
Father/Guardian Last Name  (for adults: put N/A) *
Father/Guardian Email (for adults: put N/A) *
Mother First Name (for adults: put N/A) *
Mother Last Name (for adults: put N/A) *
Mother Email
Mailing Address:
Address *
City *
Province *
Postal Code *
Contact Information:
Home *
Work
Cell
Home Language
Emergency Contact Information:
It can be a friend, a neighbor or a family member, can NOT be one of the parents if the application is for a child.
Emergency First Name *
Emergency Last Name *
Home
Work
Cell
Email
Student Medical Report:
It is very important that we are made aware of any medical conditions your child may have and what needs to be done in the event of an emergency (other than a call to 911).
Health Card
Remedy (eg. Epi-Pen)
Allergy/Medical Concerns *
Doctor’s Name
Doctor’s Phone
Student Photo Release Report:
Photos, videos, films or interviews will only be done with the prior knowledge and consent of the school principal or designate and will not be used for commercial gain. I/we hereby consent to the inclusion of photographs of my/our child in the following:
• class pictures, yearbook, special events/awards, videos and films
• photographers, films, or interviews taken by media as part of a school-related activity
• school board publications produced by the Communications Department
• photographs for use on school Internet pages and our public web sites
I/We hereby consent to the inclusion of any photographs of my/our child
Comment
Type down the method of Payment: e-transfer (full or half amount) (to: izzahlearningcenter@gmail.com) or EFT (if we have your bank information). If you choose an other method of payment; you should come to the center. If you choose the e-transfer, the student's name should be indicated in the comment box.
Charity Tool School System www.charitytool.com
Charity Tool School System www.charitytool.com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms