IJEC Student Registration Form 1445 / Aug 2023-2024
Thank You for Participating in Your Child's Education
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Email *
First Name *
Middle Initial
Last Name *
Age *
Child's Home Address *
Primary Phone Number *
Secondary Phone Number *
We encourage you to add a second phone number as a backup. If there isn't one, please re-enter the Primary Phone Number
Has Your Child Attended the IJEC Previously? *
Which other Islamic Education Program Has Your Child Attended? *
If they haven't attended a different school, please enter "No Other School"
How Would You Rate Your Child's Proficiency in Reading Arabic? *
None
Fluent
Please Enter the Parent's Full Name *
The IJEC has my permission to use my child’s/children’s photographs/videos. I understand  images may be used in print publications, email, online publications, presentations, websites, or social media . I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
I will NOT hold the Islamic Jaffaria Education Center, its administrators/committees, teachers, and all its volunteers responsible if any of my child/children are injured or harmed in any way while they attend the IJEC or at its rental premise at any location of their choosing or at any other location whereby an event/activity is held by signing below. I will also be responsible for any damage, major or minor to any property that the IJEC rents that is caused by my child/children. Consent for Treatment: I hereby by my signature give consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above retreat. It is understood that the IJEC will provide no medical insurance for such treatment, and that the cost thereof will be at my expense. *
Required
Consent for Treatment: I hereby by my signature give consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above retreat. It is understood that the IJEC will provide no medical insurance for such treatment, and that the cost thereof will be at my expense. Please type name below.
Monthly fees are collected to facilitate the purchase of books, supplies and meals. The monthly fees are: One Child = $25 / month, Two Children = $30 / month, Three or more Children = $40 / month.                                            If accommodations need to be made, please reach out to the IJEC treasurer - Sr. Deeba Taqi at 786 427-4825 or the Principal - Sr. Mumtaz Hussain at 305 606-7288. *
A copy of your responses will be emailed to the address you provided.
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