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. Child must be toilet trained. Timings 9:00 am to 12:00 pm, Monday to Thursday. One time non-refundable Registration Fee of $50. Tuition Fee first child $125/week. Siblings $100/week. Incase of financial hardship contact administration.
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: