Tahfidh Al-Qur'an boys Program Registration

Parent/Guardian Information
Father's Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Father's Occupation*
Marital Status*
Father's Residence Information (if different from child)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Mother's Occupation*
Marital Status*
Mother's Residence Information (if different from child)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1 (non-parents)
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship with child*
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 2 (non-parents)
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship with child*

Previous/Current School
School Name*
City*
Province/Territory/State*
Date Started*

MonthDayYear
Date Ended*

MonthDayYear
Has your child ever been enrolled in any special programs (e.g. Gifted, French Immersion, Special Need, ESL, IEP)? Please describe:*
Does your child have any special learning, behavioral or physical challenges? Please describe:*
Has your child ever been subject to disciplinary action (including but not limited suspension or expulsion)?
Upload latest available report card. Please upload known image or document formats (.BMP .IMG .PNG .JPG .JPEG .DOC .PDF, etc)

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Please explain if a report card is unavailable.
Copy of Birth Certificate.

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List 3 dates from today to August 30th, in order of preference, which will be used to schedule a convenient interview time with the student and his parents. However, there is no guarantee that the interview will be conducted in your preferred time slot as they will be conducted on a first come first serve basis.*
egs. 1) Sat Aug 17th PM 2) Sun Aug 18th 10am - 12pm 3) Wed Aug 21st 5pm - 9pm
Notes
Please inform us of any other vital information you think we may need to know in the event of an emergency. Thank you.
Waiver * I, as the parent and/or legal guardian of the above-named child, do hereby give my full consent and approval for my child to participate in activities at the AhleHadith Society of Canada including Walk the Qur'an program by Ilm Academy. I understand that both institutions have established guidelines, policies, and expectations that both my child and I are required to follow, and I commit to upholding these responsibilities.I understand that there are certain risks that may result in damages and injuries during the participation of my child in these activities, and I hereby accept these risks on behalf of my child. I acknowledge that AhleHadith Society of Canada and Ilm Academy have taken all reasonable and normal safety procedures to ensure the well-being ofthe participants.I hereby, for myself and on behalf of my child, agree to save and hold harmless and fully indemnify the Management, Staff, and Volunteers of both AhleHadith Society of Canada and Ilm Academy from any and all liability for any personal injury or injury to any third-party child resulting from my child’s actions/participation in the above-mentioned activities, provided that all normal safety procedures have been followed.I also release AhleHadith Society of Canada, Ilm Academy, and their entire staff and Volunteers from any and all liability, for any injuries that my child may sustain as a result of any activities taken place at the above-mentioned locations during the designated hours for the duration of my child’s enrollment in the Walk the Qur'an program.I further acknowledge that there is a $50 non-refundable registration fee for admin and testing purposes at Ilm Academy. If my child is accepted, this fee will apply towards any material fees. If space is unavailable for my child this year, their name will be placed on the waiting list for the next batch. Should I decide to withdraw my child'sregistration at any time, I understand that it will be canceled without any refund.I confirm that the information provided in this application is accurate and agree to inform the Academy staff of any changes. I am aware that all the information given in this form is treated with confidentiality and that Ilm Academy will not share it with any third party without my explicit written consent. By submitting this form, I confirm that I have read and accept the conditions outlined for my child's enrollment in the Walk the Qur'an program by/at Ilm Academy and participation in activities at AhleHadith Society of Canada.*

I agree to the above conditions.
Please verify that you are human*
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Walk The Qur'an boys Program Registration