Free Trial For Pre School 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.
Child Information
Student Name
*
First Name
Last Name
Age
*
DOB
*
-
Month
-
Day
Year
Gender
*
Please Select
Male
Female
N/A
Select Trial Week Start Date
*
-
Month
-
Day
Year
Parent/Guardian Information
Parent/Guardian 1:
*
Relationship to Student:
*
Cell Phone
*
Please enter a valid phone number.
Email Address
*
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.
Register Class
Should be Empty: