New Student Registration

Student's Health Details
Ontario Health Insurance Plan (OHIP)Private Health PlanOther
Student's OHIP Card Number *
YesNo
Family Physician's Name*

First NameLast Name
Family Physician's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Please List All of the Student's Medical Conditions and/or Allergies *
Please list all medical conditions and/or allergies
Does the student take prescription medications regularly?*
What medication(s) does the student take regularly?*
If "over-the-counter" medications are taken regularly, please include them here as well.

Primary Parent/Guardian Information

This person will be the main point of contact with Al-Risala Academy.
Primary Parent/Guardian's Full Name*

First NameMiddle NameLast Name
Primary Parent's Phone Number*
Please enter a valid phone numberFormat: (000) 000-0000.
Primary Parent's Email*

Confirmation EmailPlease enter a valid email address
Primary Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents' Information
Both Parent'sMotherFatherOther
(Under construction)Please upload any relevant legal documents

Cancelof
- Father's Name*
  
  First NameMiddle NameLast Name
- Father's Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Father's Email Address
  example@example.com
- Mother's Name*
  
  First NameMiddle NameLast Name
- Mother's Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mother's Email Address
  example@example.com

Emergency Contacts

Please Note that we require the contact information of TWO (2) different emergency contacts
- Emergency Contact's Name*
  
  First NameMiddle NameLast 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.Format: (000) 000-0000.
- Emergency Contact's Name*
  
  First NameMiddle NameLast 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.Format: (000) 000-0000.

New Student Registration Form