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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Total Fee
Monthly Fee
Payment
prev
next
( X )
Evening School Fee
Monthly Payment
USD
for the
first month
then,
USD
for each
month
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Transaction Type
Parent/Guardian Signature
*
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: