Tamim Academy of Chandler 2026-27 Application

Family Physician:*

Family Physician Phone Number*

Please enter a valid phone number.

Medical Insurance Company:*

Policy Number:*

Family Dentist:*

Family Dentist Phone Number:*

Please enter a valid phone number.

Please upload your child's most current health form and immunization records

Emergency Contact 1*

First NameLast Name

Emergency Contact 1 Phone Number*

Please enter a valid phone number.

Emergency Contact 2*

First NameLast Name

Emergency Contact 2 Phone Number*

Please enter a valid phone number.

I give permission for my child to be photographed and their photos to be placed in our advertisements, brochures, websites and social media.

Yes, I give permissionNoOther, please explain below

Other:

Emergency Contacts & Authorized Pickup
I Parent/Guardian understand that the individuals listed as emergency contacts are authorized to pick up my child and may be contacted in the event of an emergency, in addition to the parent/guardian. A child will only be released to a parent, legal guardian, or a person listed on this form. These individuals may also be contacted and authorized to remove my child from the facility in the event of illness, accident, or emergency if the parent/guardian cannot be reached.
For safety, parents must notify staff—preferably in writing or by text—of who will pick up their child, and the school may request photo ID from any authorized adult we have not met.
Release of Liability & Medical Consent
I hereby voluntarily release and waive any claims for personal injury, death, or property damage arising from participation in school activities against Tamim Academy of Chandler and its officers, agents, directors, teachers, and employees. I agree to indemnify and hold the school harmless from any such claims, including attorney’s fees or property damage. My signature constitutes informed consent and acknowledgment of this waiver.
In the event of an emergency, I give permission for my child to receive medical treatment. I consent to any necessary examination, diagnosis, treatment, or hospital care deemed advisable by our physician or another physician contacted by school leadership if I/we cannot be reached. I understand that reasonable efforts will be made to contact us first and that all related expenses are our responsibility. This consent is given in advance of treatment and remains effective until revoked.

Signature

2026-27 Application

Household Information

Parent/Guardian 1

Parent/Guardian 2

Supplemental Questions

Medical Information

Emergency Info