AMSR Summer Institute Enrollment Form

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Al Madina School will be hosting a six-week summer institute for interested students in the area of Math and English/Reading/Language Arts intervention and intervention/skill building support for Elementary and Middle/High School Math and English/Reading/ Language Arts. In addition, we will also provide support and enrichment in our Qur’an, Arabic and Islamic Studies program as well as skill building enrichment in Montessori. In addition, we will also host an end of the week school wide summer fun activity called “Thursday Fun” in partnership with area children vendors and programs geared toward ensuring summer fun for school aged children.

Please see the Summer Institute letter for more details including the schedule and pricing.

Email *

PARENT INFORMATION

Please complete the following information so we can contact you with any updates and confirmations.

Parent Name (First, Last)

Parent e-mail Address

Parent Contact Phone #

STUDENT INFORMATION

Please complete the following information about your child who will be attending the six-week Summer Institute at Al Madina School of Richmond. Complete one form per child.

Student Name (First, Last) *

Student Birthdate *

YYYY

Student school grade for 2019-2020 school year *

School attended

My child will attend the following summer Institute. *

Elementary/Title I Intervention Institute w/ Ms. Akua and Ms. Ahmara (Certified Teachers- VDOE)

QAIS Institute w/ Br. Tanveer and Sr. Salwa/Sr.Kayan

Middle/High School Intervention Institute w/ Mr. Steely and Sr. Siddiqah

Montessori Institute – Sr. Aminah and Sr. Majdoleen

Comments:

Payment Instructions

Please send full payment no later than June 21, 2019. Payment may be made with a check to the school office or by clicking the link, AFTER YOU SUBMIT THIS FORM.
CONFIRMATION FOR YOUR CHILD'S ENROLLMENT INTO THE INSTITUTE IS ONLY MADE AFTER PAYMENT IS RECEIVED.
(Weekly payments will be $120/week made via automatic weekly payments using your initial credit card information or submit the one time full payment at time of sign up).

Note: any refund requests must be submitted no later than June 24 (2 weeks before session begins).

Al Madina School of Richmond
804-330-4888
HalimahAbdulMateen@almadinarichmond.org

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