HAIC Arabic Student Registration Form

ARABIC SCHOOL REGISTRATION FORM

For Assistance in Filling up the Form Please contact Weekend Islamic School Administration at : 443-600-4904 / 443-813-3829
Registration Type*

New Student RegistrationReturning Student Registration
Student Name 1*

First NameLast Name
Birth Date 1*

MonthDayYear
Grade in Academic School 1:*
Student Name 2

First NameLast Name
Birth Date 2

MonthDayYear
Grade in Academic School 2:
Student Name 3

First NameLast Name
Birth Date 3

MonthDayYear
Grade in Academic School 3:
NOTE: For additional student(s), Please submit another registration for additional student that you want to register after submiting and paying for this registration.
Parents/Guardian Name*

First NameLast Name
Relationship to Student(s)*
Relationship
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
E-mail*
Emergency Contact

First NameLast Name
Emergency Contact Phone

Area CodePhone Number
I would like to volunteer in the Arabic School as:
Registration Cost: $20 for each child
Registration
prevnext( X )
Registration Fee (Required)$ Free

Number of Students Registering

Total $0.00
I would like to donate to help sponsor a child to attend Arabic School.

$20$40Other
ACKNOWLEDGMENT: I, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Hasbuna Allahu Islamic Center, its members, Board, Teachers, Administration, and any students for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, property damage or death that above student(s) may suffer as a result of their participation in the school, regardless of whether the injury, damage or death is caused by the negligence or fault of the releases.
I have read, understood, and accepted the ABOVE ACKNOWLEDGEMENT STATEMENT for registration.
Full Name:*
Date of Signature*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

ARABIC SCHOOL REGISTRATION FORM