Student Registration Form
Important Information:
Make sure to complete the form in its entirety. Please submit this form for all your children. If you are only registering for one child, just only fill in the first student.
Parent emails are required.
Fee is non-refundable. Registration is not complete and your child's spot will not be confirmed until a payment is made.
Kindergarten program: child must be 5 years old by October 1st of current calendar year to be eligible.
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2020-2021 Tuition
FIRST STUDENT INFORMATION
If you're only registering one child, finish only this section for "FIRST STUDENT" and then scroll down to the Parent Information section.
First Name: *
Last Name: *
Date of Birth: *
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Gender: *
Please indicate whether student is new or returning: *
Public school grade for the 2020-2021 school year: *
Sunday school grade for the 2020-2021 school year: *
SECOND STUDENT INFORMATION (if necessary)
First Name:
Last Name:
Date of Birth:
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Gender:
Clear selection
Please indicate whether student is new or returning:
Clear selection
Public school grade for the 2020-2021 school year:
Sunday school grade for the 2020-2021 school year:
THIRD STUDENT INFORMATION (if necessary)
First Name:
Last Name:
Date of Birth:
MM
/
DD
/
YYYY
Gender:
Clear selection
Please indicate whether student is new or returning:
Clear selection
Public school grade for the 2020-2021 school year:
Sunday school grade for the 2020-2021 school year:
FOURTH STUDENT INFORMATION (if necessary)
First Name:
Last Name:
Date of Birth:
MM
/
DD
/
YYYY
Gender:
Clear selection
Please indicate whether student is new or returning:
Clear selection
Public school grade for the 2020-2021 school year:
Sunday school grade for the 2020-2021 school year:
FIFTH STUDENT INFORMATION (if necessary)
First Name:
Last Name:
Date of Birth:
MM
/
DD
/
YYYY
Gender:
Clear selection
Please indicate whether student is new or returning:
Clear selection
Public school grade for the 2020-2021 school year:
Sunday school grade for the 2020-2021 school year:
PARENT INFORMATION
Father's Name: *
Mother's Name: *
Primary Home Address: *
City: *
State: *
Zip Code: *
Alternate Home Address (if different from above):
Home Phone Number
Father's Cell *
Father's Email *
Mother's Cell *
Mother's Email *
If your child has any existing medical condition that requires special attention, please indicate below:
Waiver: I want the school to obtain any medical care necessary for the welfare of my child through a qualified person, physician or hospital in case of any injury or sickness during school hours. I hereby waive all rights or claims against Darul Islah, its management, school teachers, and staff. *
Please click the link to make payment, choose "Sunday School Fee" category
https://us.mohid.co/nj/njrgn/di/masjid/online/donation
Please confirm you have made a payment. *
Parent/Guardian Signature: *
Date: *
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