MUHSEN Weekend School Student Enrollment Form 2025-2026
Weekend School program that your child is enrolling in (Masjid name/state)
*
Muslim Community of Folsom, CA
Muslim Community Association, CA
Islamic Center of Irvine, CA
West Valley Muslim Association, CA
Islamic Center of Naperville, IL
Islamic Foundation North, IL
Islamic Foundation School, IL
Bolingbrook, IL
Muslim Community Center (Strive) IL
The Mecca Center, IL
Orland Park Prayer Center, IL
New Program Fall 2025: AlHuda Foundation, Fischers, IN
New Program Fall 2025: PGMA, MD
Darul Islah, NJ
Islamic Circle of Mercer County, NJ
Islamic Center of Passaic County, NJ
Keys to Jannah- Islamic Center of Greater Cincinnati, OH
Noor Islamic Cultural Center, OH
Islamic Society of Edmond/Masjid Al Salam, OK
Muslim Association of Greater Pittsburgh, PA
New Program Fall 2025: ICBC, Austin, TX
Islamic Center of Frisco, TX
MAS Dallas, TX
MCECC/Al Madinah Masjid, TX
New Program Fall 2025: ADAMS Center, Sterling, VA
Muslim Association of Puget Sound- Redmond, WA
ISM Brookfield, WI
MCC - Muslim Community Center- Pleasanton, CA
Are you a new or returning student?
*
New student
Returning student
Child's name, First and Last
*
Date of birth
*
Gender
*
Male
Female
Diagnosis
*
Have you taken the MUHSEN Needs Assessment?
*
yes
no
I am interested in enrolling my special child in the
*
the special needs classroom (self-contained)
the regular Saturday or Sunday School class, with assistance
Back
Next
Contact information
Address (Please be accurate)
*
Mother's name, First and Last
*
Mother's phone number
*
Father's name, First and Last
*
Father's phone number
*
Primary email address
*
Additional emergency contact person
*
Additional emergency contact's phone number
*
Back
Next
Educational information
Current school placement: (Please bring copy of IEP at time of registration)
*
Public school
Private school
Private therapy center
Homeschool
Therapies currently receiving: (Please bring copy of most recent evaluations at time of registration)
*
Speech therapy
Occupational therapy
Behavioral therapy (ABA)
Physical Therapy
None
My child's main mode of functional communication is:
*
Spoken language
Sign language
Using gestures
With a communication device
Using Picture Exchange Communication System (PECS)
Little or no communication
My child's favorite activities are:
*
My child has an aversion to:
*
Does your child enjoy music?
*
yes
no
What things can best be used to motivate your child?
*
Verbal praise
Hugs, hi fives
Behavior chart, tokens
Stickers, stamps
Candy
Preferred activity or sensory break
My child is most relaxed when:
*
alone
one on one
in a small group
in a large group
Back
Next
Self help skills
My child
*
can use the restroom independently
can use the restroom independently, but needs to be escorted
needs assistance in the restroom
wears a diaper and is dependent for restroom care
My child
*
eats independently
needs assistance for meal times
is dependent for meal times
My child
*
can function independently in a large group
can function independently in a small group
requires one on one assistance in a group setting
Back
Next
Behavioral information
My child gets upset or can potentially have a meltdown when:
*
If my child has a meltdown, he is best calmed by:
*
When my child is upset, he/she may:
*
cry, scream
flop to the floor
kick, hit, pull hair, pinch
bite
aggress towards peers
Does your child have a tendency to elope?
*
yes
no
Back
Next
Medical information
Please list any additional medical diagnoses that your child has.
*
Please list medications that your child takes.
*
Has your child ever had a seizure?
*
Yes
No
If yes, please describe the seizure type, what may prompt a seizure, and how to best respond.
*
Please list any allergies that your child has.
*
Child's pediatrician:
*
Pediatrician's phone number:
*
Hospital that your child should be taken to in the event of a medical emergency:
*
Back
Next
Parent's goals and expectations
What would you like your child to achieve from attending Islamic Weekend School?
*
Back
Next
Permission to Photograph
I give permission for MUHSEN to photograph my child for promotional purposes.
*
Yes
No
Back
Next
Permission for Outdoor Activity
I give permission to MUHSEN Lead Teacher to take out my child on school grounds for gym activities.
*
Yes
No
Back
Next
Important Enrollment Notice
*
I understand that once my child is approved into the program, I will receive a confirmation email and must pay a $100 non-refundable MUHSEN program fee to complete enrollment. This fee does not include the masjid or school’s tuition.
Submit
Should be Empty: