After School Registration Aug 2025 to May 2026

After School Registration August 2025 to May 2026

Please fill out this form to register your child. Filling out this form does not guarantee participation in the program, which is based on a first come, first serve basis until all available spots in each grade level are filled up. You will be informed of successful admission or otherwise by our staff.
Student Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade. Only grades listed below are available for Registration. Rest all are filled up.*
Gender*

MaleFemale
Parent/Guardian Information
Name*

First NameLast Name
Relationship to student*

MotherFatherGrandparentOther
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information

Please add another emergency contact in case we cannot get in touch with the main parent/guardian.
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Email
example@example.com
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Al-Rahmah Islamic Center (Masjid jafar) during the selected school session. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Al-Rahmah Islamic Center Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected sessions. In case of injury to said child, I hereby waive all claims against Al-Rahmah Islamic Center Inc. including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Photo Release Consent.*

I hereby allow the reproduction and publication of my child's photograph(s)I do not allow the reproduction and publication of my child's photograph(s)
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I ACKNOWLEDGE THAT I AM ENROLLING IN A FULL YEAR OF AFTER-SCHOOL FROM AUGUST 2025 TO MAY 2026

I WILL MAKE ALL THE PAYMENTS AS PER THE CHOSEN OPTION BELOW. I UNDERSTAND THAT THERE IS NO CANCELLATION AFTER REGISTRATION. THIS SUBSCRIPTION IS NON-REFUNDABLE.

The first payment will be charged on August 15th for parents who sign up before this date. The rest will be charged as soon as you register the kids.

My Products*

After School Ten payment Payment OptionSunday School Monthly Payment Option $75 per month for 10 months.

$100.00 for the first month then,$75.00 for each month

After School Two Payment OptionAfter-School Two Payment Option for $300. Recurring every six months.

$325.00 for the first payment then,$300.00 for each six months

After School One time Payment OptionAfter-School One Time Payment Option You will be charged $600.

$625.00 for the first year then,$600.00 for each year

Enter coupon

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Terms and Conditions Acknowledgement. *

I have read all the terms and conditions related to After School Enrollment and understand all the financial and educational requirements as described in the enrollment form. I also understand that the tuition fees are nonrefundable once online enrollment is completed.
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After School Registration August 2025 to May 2026