ISLAMIC SCHOOL OF MUNCIE

Registration Form
Spring 2015

CONTACT INFORMATION:
Father _______________________________
(Last, First)

Mother _______________________________
(Last, First)

Phone ________________________________

________________________________

Cell Phone ____________________________

________________________________

Email ________________________________

________________________________

Native Language _______________________

________________________________

Home Address _______________________________________________________________________

Which language does your child speak at home? English ( ) other language ( ________________)

Student Name

Date of Birth

(MM/DD/YYYY)

Gender
(M/F)

Allergies

1
2
3
4
5
6

Who to call in case of emergency if parent is not available:

Name: __________________________________

Phone:___________________________________

Relationship to student: __________________________

PAYMENT INFORMATION:

Student Name

Tuition Due
$75 per semester

1
2
Total Tuition Due =
1. I will pay full tuition with check/cash.

Semester (Please pay $75)

Monthly (Please pay $25 x3 - at the beginning of every month from January to March).
Failure to pay on time will result in a $10 late fee. After 2 weeks of non-payment, children will be
asked to stay at home. All fees are used to fund our programpay for books, supplies, snacks, and
upkeep of classrooms.
2.

I am financially incapable to pay all tuition dues this semester (note this is confidential
and will not be shared).

Donations Needed: For those parents who are financially able, we would appreciate any extra
amount you would like to add to your envelope.
IMPORTANT NOTES FOR PARENTS
Please initial each of the following:
1. All children need to bring a backpack to school with all assigned homework, books, and
pencil to each session _____.
2. Parents are responsible to go through their childs schoolwork each week and communicate
with the teacher via email if needed _____.
3. If the child is not attending school, parents must email the principal at
(ismuncie@gmail.com) _____.
4. A small snack will be provided during the snack break, please make sure your child has
breakfast before arriving at school_____. (Please indicate to us any allergy issues and
information)