Azan Summer Program Registration

ACC Summer Program

Registration Form
Limited spots available. Enrollment is on a first-come, first-served basis.
Student Information

First NameLast Name
Student Age
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENTS INFORMATION
PARENT 1

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
PARENT 2

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

EMERGENCY CONTACTS
CONTACT 1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (work)
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
CONTACT 2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (work)
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Please list any allergies, medical conditions, medications, or other health concerns that may affect your student's participation in the program or that staff should be aware of in case of an emergency.
Details

Admission and Acceptance Policy

To accept your child(ren), parents must fulfill the following conditions:

Condition #1

A. Acceptance is for the children of cooperative parents and new enrollments are on a first come first-serve basis.

B. Your child’s registration will be confirmed when the non-refundable registration fees are paid in full, the file is complete, and the parents are interviewed with the principal and assigned committee.

C. Might reject or dismiss any student who performs below average academically.

D. Please understand that has the right to reject or dismiss at any time during the school year any student requiring behavioral counseling, exhibiting poor self-control or who violates the requirements, regulations and policies set by.

E. May reject or dismiss student(s) from classes and school if the late tuition is not paid in full by the end of the month and before the first school day of the following month.

F. Will reject and dismiss student(s) of non-cooperative parents.

Condition #2

A. Participating and supporting all the school and Educational Association’s meetings, functions and/or other activities.

B. Responding to all memos and returning them to the school with the student the following day.

Condition #3

The following documents and conditions are needed for admission to School:

A. Completing School registration forms.

B. Paying of all required fees such as registration and book fees.

C. Transcripts from previous school.

D. Immunization records.

E. Academic progress report of achievement.

F. Passing the admission test for new students.

G. Parental interview with the principal.

Media Consent

We love sharing highlights from our program with families and the community. By registering your student, you give permission for photos and videos taken during program activities to be used on our website, social media pages, flyers, newsletters, and other promotional materials.

We will not share personal information about your student without permission. If you prefer that your student not appear in photos or videos, please let us know in writing before the program begins.

I/We understand that is dedicated in providing Islamic Education that is aimed to build a firm Islamic background for my/our child(ren). Institution’s administration will do its’ best for my/our child(ren) Islamic upbringing Insha’Allah.

Will contact the parents/guardian regarding acceptance and rejection of the child(ren) upon meeting and completing all the above conditions.

I assume all incidental risks and/or hazards related to or its activities, transportation. I further hereby release and waive all rights and claims against, the school principal, officers, instructors, helpers, teachers, drivers, executive council, board of trustees any or all of them. I further understand that does not provide accidental insurance or any other form of insurance for the student(s). I hereby fully consent to emergency medical care to be rendered by competent medical physicians in the event the aforementioned child should require such attention during this activity.

By signing this contract, I accept the admission and registration policy, the tuition policy and other obligations inherent in registering my child(ren) at. I also agree to the policy of the school stated on handbook.
Signature of responsible parent/guardian:

PAYMENT
Tuition & Payment Options

Payment is required to secure enrollment in the Summer Program. Please note that a student’s spot is not guaranteed or reserved until payment has been received.

Families may choose one of the following payment options:

$300 One-Time Payment – Covers the full 2-month Summer Program.
$150 Monthly Payment Plan – Two monthly payments of $150 each.

Please Note:
Students enrolled in the monthly payment plan must be enrolled in automatic recurring payments for the duration of the program.

Zelle Payment: Selecting Zelle only lets us know your preferred payment method. After submitting the form, please send your payment via Zelle. Registration is not complete until payment is received.
Payment Methods (please select one)
My Products
prevnext( X )
Registration Fee
$1.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

ACC Summer Program

My Products

Payment Methods