26-27 Academics Grades & Tahfeez 4-12

26-27 Academics Grades & Tahfeez 4-12

26-27 Academics Grades 4-12 & Tahfeez

New Student Enrollment Form
Please note that you will be required to submit the following documents at the end of this form.

Be sure to have all the required information and paperwork ready before you begin the application process. You may submit them through this form OR bring it with you to our registration office.

1. Copy of passport or birth certificate of the child

2. Valid ID of parent or guardian

3. Child's latest report card from school

4. Current immunization records

Ensure that each document is clear and readable. Submit clear images.

Missing documents or incorrect documentation will delay the review process.
STUDENT INFORMATION
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Place of Birth*
Gender*
Citizenship*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Language(s)*

PRESENT SECULAR EDUCATION
Name of School*
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Completed*
Grade Admission*
Duration Attended
Reason for Leaving The School

PRESENT RELIGIOUS EDUCATION (If any)
Name of Institute Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duration Attended
Number of Times Nazirah Has Been Completed
Visual recital with looking inside the Quran
Amount of Quran Memorized
Reason for Leaving The School
How much Quran do you want your child to memorize in this program?

PARENT/GUARDIAN INFORMATION
Father*

First NameLast Name
Mother*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Language*
Father's Email*
example@example.com
Mother's Email*
example@example.com
Father's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Father's Occupation/Job*
Mother's Occupation/Job*

EMERGENCY CONTACT
Name

First NameLast Name
Relationship to Student
Language
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code