Full Time Hifdh - Health Forms 2026-2027

Full Time Hifdh - Health Forms 2026-2027

Kindly upload all health forms required as part of the 2026-2027 Full Time Hifdh Enrollment at Iqra Academy, Islamic Foundation. All exams should be from within the last 10 months.
PARENT INFORMATION
Primary Parent Full Name

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

First NameLast Name
Secondary Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Parent Email Address
example@example.com
EMERGENCY CONTACTS
Primary Emergency Contact

First NameLast Name
Primary Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Emergency Contact Email
example@example.com
Primary Emergency Contact Relationship to Student(s)
Secondary Emergency Contact

First NameLast Name
Secondary Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency Contact Email
example@example.com
Secondary Emergency Contact Relationship to Student(s)
STUDENT INFORMATION
- Student #1 Name
  
  First NameLast Name
- Student #1 Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- List any medications with dosages taken regularly. (Write NA if not applicable)
- List any allergies of the child. (Write NA if not applicable)
- Kindly upload Allergy Action Plan and bring appropriate medication/Epipen to school nurse on first day. (If applicable)
- Cancelof
- Kindly upload Student Physical Form with Immunizations. If you choose not to vaccinate, please fill out top "Health History" portion only and add Religious Exemption form, found below.
- Cancelof
- For those who do not vaccinate, kindly upload Religious Exemption Form.
- Cancelof
- Kindly upload Eye Exam.
- Cancelof
- Kindly upload Dental Exam.
- Cancelof
- Kindly upload Hearing Test.
- Cancelof
- Kindly upload Asthma Action Plan. (If applicable)
- Cancelof
- Do you have another child to register?
- Student #2 Name
  
  First NameLast Name
- Student #2 Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- List any medications and dosages taken regularly. (Write NA if not applicable)
- List any allergies of the child. (Write NA if not applicable)
- Kindly upload Allergy Action Plan and bring appropriate medication/Epipen to nurse on first day. (If applicable)
- Cancelof
- Kindly upload Student Physical Form with Immunizations. If you choose not to vaccinate, please fill out top "Health History" portion only and add Religious Exemption form, found below.
- Cancelof
- For those who do not vaccinate, kindly upload Religious Exemption Form.
- Cancelof
- Kindly upload Eye Exam.
- Cancelof
- Kindly upload Dental Exam.
- Cancelof
- Kindly upload Hearing Test.
- Cancelof
- Kindly upload Asthma Action Plan. (If applicable)
- Cancelof
- Do you have another child to register?
- Student #3 Name
  
  First NameLast Name
- Student #3 Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- List any medications and dosages taken regularly. (Write NA if not applicable)
- List any allergies of the child. (Write NA if not applicable)
- Kindly upload Allergy Action Plan and bring appropriate medication/Epipen to nurse on first day. (If applicable)
- Cancelof
- Kindly upload Student Physical Form with Immunizations. If you choose not to vaccinate, please fill out top "Health History" portion only and add Religious Exemption form, found below.
- Cancelof
- For those who do not vaccinate, kindly upload Religious Exemption Form.
- Cancelof
- Kindly upload Eye Exam.
- Cancelof
- Kindly upload Dental Exam.
- Cancelof
- Kindly upload Hearing Test.
- Cancelof
- Kindly upload Asthma Action Plan. (If applicable)
- Cancelof
- Do you have another child to register?
- Student #4 Name
  
  First NameLast Name
- Student #4 Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- List any medications and dosages taken regularly. (Write NA if not applicable)
- List any allergies of the child. (Write NA if not applicable)
- Kindly upload Allergy Action Plan and bring appropriate medication/Epipen to nurse on first day. (If applicable)
- Cancelof
- Kindly upload Student Physical Form with Immunizations. If you choose not to vaccinate, please fill out top "Health History" portion only and add Religious Exemption form, found below.
- Cancelof
- For those who do not vaccinate, kindly upload Religious Exemption Form.
- Cancelof
- Kindly upload Eye Exam.
- Cancelof
- Kindly upload Dental Exam.
- Cancelof
- Kindly upload Hearing Test.
- Cancelof
- Kindly upload Asthma Action Plan. (If applicable)
- Cancelof
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Full Time Hifdh - Health Forms 2026-2027

PARENT INFORMATION

EMERGENCY CONTACTS

STUDENT INFORMATION