MAB ASQIS Application

Bismillahi Al-Rahman Al-Raheem

Welcome to the MAB ASQIS: After School Quran and Islamic Studies program. Our program is available to children between the ages of 5 - 16. We offer Nadhirah and Quran classes. Along with that, students are also taught Fiqh, Aqa'id, Seerah, History, Ahadith, Akhlaq, Surah Memorization and Duas. Please read through the details and complete the form in its entirety. once you've submitted the form you will recieve aresponse within 24-48 hours of your enrollment decision. May Allah accept your decision to provide yourchild/ren with an islamic education.

Tuition & Fees:

Parents must sign the MAB After School Islamic & Quranic Studies Program Policies & Procedures – the current document indicating that they accept the policies and will abide by it.

The tuition fees for the program are as follows:

1. One Student $75/month per child

2. Two students - $150

3. Three - $225

4. If you're not able to pay the fees, please email mabmaktab@bolingbrookmasjid.net

Payment Schedules:

All payments are due by the 5th of each month. If students go on extended vacation with school permission, no deduction or remission of tuition is allowed for the absence so as to reserve their seat in the school. If a student is enrolled in the school during a month, parents are obligated to paythe tuition fee in full for that month, notwithstanding the subsequent absence, withdrawal or dismissal from the school. Families having difficulty making payments must contact the school enrollmentadministrator at mabmaktab@bolingbrookmasjid.net or the treasurer at treasurer@bolingbrookmasjid.com.

Late and Delinquent Payments:

A $30 late fee is charged after the 5th of the month. In the event that tuition payments are not made on time a notice will be sent to the parent or guardian. If payment is notmade or specific arrangements for payment are not provided in writing within seven (7) days then it mightlead to additional penalty.

Financial Aid:

The Masjid currently has a financial aid program to ensure that those deserving students whose families have demonstrated financial need can take benefit from it.

Student Progress:

• Any questions or meeting with teachers will have to be scheduled OUTSIDE of school hours. The parent may arrange a meeting either before class or after based on the teachers availability.

• There are two terms in the academic year.This will include 3 parent teacher confrences which will be mandatory to attend unless a valid excuse is provided.

• Parents can email any issues, concerns, questions to mabmaktab@bolingbrookmasjid.net or your child/ren's instructor. The administration will try to respond within 48 hours of receipt of the e-mail.

Abcences:

Students are allowed 14 unexcused absences in the entire school year. Three tardies will be counted as one abcense. Excused absences will only be excused if a valid reason is provided and the teacher is informed of your child/ren's absences. After 14 unexcused abcenses you will be sent home a letter to sign and return. Further abcenses can result in your child/ren being dismissed from the program.

Dress Code

Girls: 5-10 modest clothing, long sleeve, minimum knee length, hijab.

Girls: 11-14 Abay, Hijab

Boys: kufi/topi, kurta or thobe.

Not Allowed for Both Girls and Boys

Sports wear of any kind, skin tight clothes, skinny jeans, leggings, short sleeve shirts or dresses, jewelry, smart devices of any kind.

Drop Off & Pick Up:

Maktab classes start from 4:30 PM and end at 6:30 PM. Parents are responsible for dropping and picking up their child/ren. The school is not responsible for students dropped off 15 minutes before class time and 10 minutes after dismissal. The parent must not pick up their child no later than 10 minutes after class has ended. If a parent arrives later than 10 min then a fee of 20 dollars may be charged per violation.
By checking this box I acknowledge all of the above rules and regulations of MAB ASQIS
Page 1 of 6

Parent/Guardian Information
Father/Guardian Name*

First NameLast Name
Cell Phone*
Format: 000-000-0000.
Home Phone
Format: 000-000-0000.
Work Phone
Format: 000-000-0000.
E-mail*
example@example.com
Mother/Guardian Name*

First NameLast Name
Cell Phone*
Format: 000-000-0000.
Home Phone
Format: 000-000-0000.
Work Phone
Format: 000-000-0000.
E-mail*
example@example.com
On-siteOnline
Masjid Al IslamMasjid Al Jumua'h
Page 2 of 6

Information for Child 1
Name of Student 1*

First NameMiddle NameLast Name
Grade *
Birth Date*

MonthDayYear
Gender:*
Secular School
Medical Needs for Child 1
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
NoYes
Page 3 of 6 (Child 1)

Information for Child 2
Name of Student 2*

First NameMiddle NameLast Name
Grade*
Birth Date*

MonthDayYear
Gender:*
Secular School
Medical Needs for Child 2
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
NoYes
Page 3 of 6 (Child 2)

Information for Child 3
Name of Student 3*

First NameMiddle NameLast Name
Grade*
Birth Date*

MonthDayYear
Gender:*
Secular School
Medical Needs for Child 3
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
Page 3 of 6 (Child 3)

Emergency Contact Information
Emergency Contact 1*

First NameLast Name
Relationship to Student*
Emergency Contact 1 *
Format: (000) 000-0000.
Emergency Contact 2*

First NameLast Name
Relationship to Student*
Emergency Contact 2*
Format: (000) 000-0000.

Waiver, Release, Indemnity, Acknowledgment of Risk, and Conditions of Enrolment:
As parent and/or legal guardian for my child/ren listed below. I understand that injuries can arise by accident and do hereby release and forever discharge Muslim Association of Bolingbrook. of 560 N Frontage Road. Bolingbrook, IL 60440,and 351 Veterans Pkwy. Bolingbrook. IL 60490, their agents. employees, successors and assigns. and their respective heirs. personal representatives. affiliates, successors and assigns. and any and all person. finns or corporations liable or who might be claimed to be liable. whether or not herein named. from any and all claims. demands. damages. actions. cause of action or suits of any kind or nature whatsoever, whether know or unknown, fixed or contingent. which I now have or may hereafter have or claim to have. as a result of or in any way relating to the following:

Release from any/all liability to do accidental injury caused on the premises by me. child/children, spouse, family member, friend(s) or inflicted upon by any person/object within/outside the property located at 560 E N Frontage Road, Bolingbrook. IL 60440. also known as Masjid Al-Islam and 351 Veterans Pkwy. Bolingbrook, IL 60440, also known as Masjid AL-Jumu·ah.

It is understood and agreed that no settlement or payments and satisfaction of the aforesaid actions. causes of action, claims and demands: that this Release contains the entire agreement between the parties: and the terms of this Agreement are contractual and not merely a recital. Furthermore, this Release shall be binding upon the undersigned. and his respective heirs, executors. administrators, personal representatives. successors and assigns. This Release shall be subject to and governed by the laws of the State of Illinois.

I hereby authorize the Muslim Association of Bolingbrook, its employees and volunteers to seek emergency medical assistance and treatment for my child named in this application if the parents/guardians or emergency contact cannot be contacted.
By signing below I agree to all of the above stated information.

If you have one or two children, then put N/A in the 2nd or 3rd child area.
Child 1*

First NameLast Name
Child 2*

First NameLast Name
Child 3*

First NameLast Name
Signature*

Clear

MAB Covid-19 Liability Waiver
Dear parents, the following is a guideline for classes being held on-site at Masjid Al-Jumuah and Masjid Al Islam. This waiver must be signed by the parents of every student to attend on-site classes.

Guidelines
- Mandatory temperature check
- Face shield/Mask required at all times covering the mouth and nose
- No sharing of equipment, books, and food by the students
- Students who exhibit symptoms or feel sick whilst in class will be picked up by their parent/guardian upon notice

Covid
- If the student or a household member comes in contact with an individual who tested positive for covid- 19 or its variants, stay home for the 14 day quarantine period
- If the student traveled anywhere outside of the state or country observe the 14 day quarantine period and return afterwards
- If student is experiencing any symptoms of being ill then stay home and notify the teacher

Disclaimer
The threat of Covid-19 is not yet over. By sending your child/children to attend on-site classes, you agree and accept the level of risks involved with potential exposure and will not hold Muslim Association of Bolingbrook, its staff, and its volunteers responsible from any harm that may arise due to your child/children attending on-site classes.
I, blanks* hereby read and acknowledged the above and accept the risks involved in sending my child/ren on-site for learning. Date of acknowledgement blank.
YesNo
*For financial aid please email mabmaktab@bolingbrookmasjid.net
Should be Empty:

Parent/Guardian Information

Information for Child 1

Medical Needs for Child 1

Information for Child 2

Medical Needs for Child 2

Information for Child 3

Medical Needs for Child 3