Preschool Registration Form
Please fill out this form to the best of your ability. If you are enrolling more than one child, kindly fill out a separate form. Al-Minhal Academy of Washington Township.
Basic Program Information
Ages 3-5 Years. Monday to Thursday. One time non-refundable Registration Fee of $50. Tuition Fee: Half day -9:00 am to 12:00 pm $125/week or $70 for 2 days a week. Full Day - 9:00 am to 3:00 pm $160/week or $90 for 2 days a week Extended hours before and after school available.
Select a program
Half day program / 4 days
Half day program/2 days
Full day program/4 days
Full day program/2 days
If you would like supervision before or after school hours let us know the timings you need.
Child Information
Student Name
*
First Name
Last Name
Age
*
DOB
*
-
Month
-
Day
Year
Gender
*
Please Select
Male
Female
N/A
Public School Grade
*
Parent/Guardian Information
Parent/Guardian 1:
*
Relationship to Student:
*
Parent/Guardian 2:
Relationship to Student:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email Address 1
*
example@example.com
Email Address 2
example@example.com
Medical Information
Any Medical Problems or Needs
Allergies
Emergency Contact Number
Other than provided above
Name
*
Phone Number
*
Please enter a valid phone number.
My Products
*
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Registration Fee
One Time Registration Fee
$
50.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Register Class
Should be Empty: