2025-2026 Evening School Registration Form
IMPORTANT INFORMATION
Age: 4+
Monday - Thursday: 5 pm - 7 pm
Tuition: $60 per child
Sibling discount: $10 off per child(2nd child onward)
$5 processing fee will be charged on late payments after the 5th of the month
Qai'dah Book $20
Number of Children
*
Please Select
1
2
3
4
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Male
Female
Public School Grade for the 2025-2026 School Year
*
Please Select
KG
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Will they need a Qa'idah Book?
Yes
No
Does your child have any existing medical condition that requires special attention?
*
Yes
No
If yes, please explain
Child 1 Fee
*
Second Child's Full Name
*
First Name
Last Name
Second Child's Date of Birth
*
-
Month
-
Day
Year
Date
Second Child's Age
*
Second Child's Gender
*
Male
Female
Public School Grade for the 2025-2026 School Year
*
Please Select
KG
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Will they need a Qa'idah Book?
Yes
No
Does your child have any existing medical condition that requires special attention?
*
Yes
No
If yes, please explain
Child 2 Fee
*
Third Child's Full Name
*
First Name
Last Name
Third Child's Date of Birth
*
-
Month
-
Day
Year
Date
Third Child's Age
*
Third Child's Gender
*
Male
Female
Public School Grade for the 2025-2026 School Year
*
Please Select
KG
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Will they need a Qa'idah Book?
Yes
No
Does your child have any existing medical condition that requires special attention?
*
Yes
No
If yes, please explain
Child 3 Fee
*
Fourth Child's Full Name
*
First Name
Last Name
Fourth Child's Date of Birth
*
-
Month
-
Day
Year
Date
Fourth Child's Age
*
Fourth Child's Gender
*
Male
Female
Public School Grade for the 2025-2026 School Year
*
Please Select
KG
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Will they need a Qa'idah Book?
Yes
No
Does your child have any existing medical condition that requires special attention?
*
Yes
No
If yes, please explain
Child 4 Fee
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Full Name
*
First Name
Last Name
Father's Phone Number
*
Please enter a valid phone number.
Father's Email Address
*
example@example.com
Mother's Full Name
*
First Name
Last Name
Mother's Phone Number
*
Please enter a valid phone number.
Mother's Email Address
*
example@example.com
Emergency Contact 1 Name
*
First Name (Must be someone other than parent)
Last Name
Emergency Contact 1 Phone Number
*
Please enter a valid phone number.
Emergency Contact 2 Name
*
First Name (Must be someone other than parent)
Last Name
Emergency Contact 2 Phone Number
*
Please enter a valid phone number.
Total Fee
Monthly Fee
Payment
prev
next
( X )
Amount Due
Monthly
USD
for the
first month
then,
USD
for each
month
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Transaction Type
Parent/Guardian Signature
*
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: