Al-Risala Academy Student Registration
Please complete the following form in its entirety.
Primary Parent/Guardian Information
This person will be the main point of contact with Al-Risala Academy.
Primary Parent/Guardian's Full Name
*
First Name
Middle Name
Last Name
Primary Parent's Phone Number
*
Please enter a valid phone number
Primary Parent's Email
*
Confirmation Email
Please enter a valid email address
Primary Parent/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parents' Information
Student Lives with (Custody Status):
Both Parent's
Mother
Father
Other
Father's Information
Father's Name
*
First Name
Middle Name
Last Name
Father's Phone Number
*
Please enter a valid phone number.
Mother's Information
Mother's Name
*
First Name
Middle Name
Last Name
Mother's Phone Number
*
Please enter a valid phone number.
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Emergency Contacts
Please Note that we require the contact information of TWO (2) different emergency contacts
Emergency Contact #1
Emergency Contact's Name
*
First Name
Middle Name
Last Name
Emergency Contact's Relationship to Student
How is this emergency contact related to the student(s) you are registering?
Emergency Contact's Phone Number
*
Please enter a valid phone number.
Emergency Contact #2
Emergency Contact's Name
*
First Name
Middle Name
Last Name
Emergency Contact's Relationship to Student
How is this emergency contact related to the student(s) you are registering?
Emergency Contact's Phone Number
*
Please enter a valid phone number.
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Student's Health Details
Student's Health Coverage Plan
*
Ontario Health Insurance Plan (OHIP)
Other
Student's OHIP Card Number
Family Physician's Name
First Name
Last Name
Family Physician's Phone Number
Please enter a valid phone number.
Does the Student Have any Medical conditions and/or Allergies
Yes
No
Please List All of the Student's Medical Conditions and/or Allergies
Please list all medical conditions and/or allergies
Is the student taking medication(s) on a regular basis?
Please Select
Yes
No
What medication(s) does the student take on a regular basis?
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Student's Personal Details
Please ensure that all student details are correct and up to date.
Student's Information
Student's Full Name
*
First Name
Middle Name
Last Name
Student's Sex
*
Male
Female
Student's Date of Birth
-
Month
-
Day
Year
Date
Student's First Language
Student's Educational History
Student's Previous School
*
Please Select
Public School
Catholic School
Private School
Home School
Canadian School Outside Ontario
School Outside Canada
Country of Previous School
Province of Previous School
Name of Previous School
Primary Language of Previous School
English
French
Other
Does the Applicant have an Individual Education Plan (IEP)?
Yes
No
Please Provide Details Regarding the Applicant's Individual Education Plan (IEP)
Was the Applicant Ever Suspended?
Yes
No
Please Provide Details Regarding the Applicant's Previous Suspensions.
Was the Applicant Ever Expelled?
Yes
No
Please Provide Details Regarding the Applicant's Previous Expulsions.
Enrolment Start Date
*
-
Month
-
Day
Year
What day would you like for the applicant to start attending Al-Risala Academy?
What Grade will the Applicant Attend at Al-Risala Academy?
Please Select
Pre-K (Montessori Program)
Junior Kindergarten (Montessori Program)
Senior Kindergarten (Montessori Program)
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
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Signature
Please verify that you are human
*
Submit
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