Al-Firdows

Academy
RegistrationForm
Section 1: Student Information
Students Name

Date of
Birth

No

Country of
Birth

Gend
er

Grade in
Public
School

1
2
3
4
5
*Use additional forms for enrolling more then five children

Previous Islamic School Information:

Has the child attended Islamic School previously? _ No _ Yes _
Name: _________________________________ Level: ___________________ City: _____________
Section 2: Parent Information
Fathers Name: _______________________________ Mb:
HP:
Mothers Name: _____________________________
Mb:
HP:
Home Address: _______________________________City: ________________ State/Zip: ______________
Email: _______________________________________ Emergency Contact: _________________________
Section 3: MEDICAL INFORMATION

Do any of your children have any existing medical condition that requires special attention? If yes, please
explain:_______________________________________________________________________________
Has the student ever had psychological testing or been screened for academic difficulties or learning
disabilities? YES ____ NO ____
Any health concerns (allergies, asthma, diabetes, etc.)? YES ____ NO ____
If yes, please explain:
__________________________________________________________________________________________

Prescription Medication: YES ____ NO ____

If yes, please explain:
Family Doctor: _____________________________________

Phone: ___________________________

Address:________________________________________________

Postcode:_______

We want the school to obtain any such medical care as necessary for the welfare of my children through a
qualified person, physician or a hospital in case of any injury or sickness during school hours. We hereby waive
all rights or claims against the school and the Masjid, its teachers and staff, Executive council and the board of
trustees.
Parent/Guardian signature: __________________________________________________________________
Print Name:

______________________________________ Date: _______________________

Section 4: EMERGENCY CONTACTS (OTHER THAN ABOVE NAMES)

Name: _______________________________________ Relationship: ____________________
Phone: _____________________
Name: _______________________________________ Relationship: ____________________
Phone: _____________________
Section 5: Tuition/Fee
Level 1- Level 3
$ 30/mon per
Child

Level 4 to
Intermediate
$35/mon per
Child

Please choose from the following

Quranic Reading
Study Mode
Saturday Class

advances

English and
Maths
$ 50/mon per
Child

$ 45/mon per
Child

Science and
others
$ 40/Hr

Islamic Studies

Academic Studies

Sunday Class

Online

SCHOOL OFFICE USE ONLY

Date Received:
Notification of Acceptance Issued:
Denied

Status:
Grade:

Waiting List

Accepted

Offer of Enrolment:

Year:
Accepted