Monday to Thursday, 7.20 am to 7.50 am* Sept 14, 2026 to May 27, 2027

Important: Daily Limit of 8 students only

1st Child's Name:

2nd Child's Name:

3rd Child's Name:

Father's Name:

Mother's Name:

Home Address:

Home Tel:

Emergency Contact Person's Name:

Student's Primary Care Physician's Name:

Health Insurance Provider & Number:

Please list Allergies (if any):

Please Select Program (please circle) :

2nd child

Specify days:

Total fees:

Important Details:

Adhoc/Drop-in Daily Rate*:

*Subject to space availability

2. Full payment must accompany each application; checks made payable to Al-Noor Acaademy.

4. Any alteration to your contracted schedule must be made in writing with minimum of one week's notice.

Note: Frequent switching of days is not permitted.

5. There can be no credits or refunds for any unused hours/days including sick days, or snow closing

due to inclement weather.

6. *Before-School care runs 30 minutes before regular opening. On days of delayed openings, program runs

only 20 mins prior to announced opening time. NO before-school on days of announced Snow Days.

Parent Acknowledgement:

1. I have read the above important details of the program and agree to all the stipulations.

2. In the unforeseen event that my child requires immediate medical attention, and neither myself, my spouse nor the

Emergency Person indicated above are contactable, I hereby authorize ANA's Before-School Program staff to seek necessary

aid, including and not limited to calling 911.

Parent Name:

Parent Signature: