Student Enrollment Form for Dar Al-Arqam Institute

Student Enrollment Form for Dar Al-Arqam Institute

Complete this form to apply for enrollment at Dar Al-Arqam Institute for students from Preschool to 5th Grade.
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

Other
Grade Applying For
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous School Attended (if any)
Previous School Name
Previous Grade
Previous Section
Does the student have any medical conditions or allergies?
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian E-signature
Should be Empty: