Masjid Noor Ul Huda

TUTORING CLASSES

REGISTRATION AND ADMISSION FORM PLEASE PRINT CLEARLY AND USE ADDITIONAL FORM FOR MORE THAN THREE CHILDREN

STUDENT # 1 NAME: _____________________________________________ AGE: ___________ SEX: M / F GRADE: _________ STUDENT # 2 NAME: _____________________________________________ AGE: ___________ SEX: M / F GRADE: _________ STUDENT # 3 NAME: _____________________________________________ AGE: ___________ SEX: M / F GRADE: _________

ADDRESS: _______________________________________________________________________________________________ PARENT’S/GUARDIAN NAME: ________________________________________________________________________________ HOME PHONE: ________________________WORK PHONE:________________________CELL PHONE:_____________________ E-MAIL ADDRESS: _________________________________________________________________________________________

We the Parents/Guardians/Myself (undersigned) agree to abide by all the rules and regulations as specified out by management, volunteers and teachers at the School. We also agree that ICC will not be responsible for any injury, damage or loss of any kind which may occur in Masjid Noor-Ul-Huda Islamic Center on or around the property involving any teacher, students, ICC officers, visitors, guests and/or volunteers. Parents are required to drop their children and pick them after School time. If any reason the Parents cannot make it on time, please make an alternate arrangement to pick up your child. Please inform the school management so they can let go your child with your assigned person.

_____________________________________________________________________________________ PARENT/GUARDIAN NAME

SIGNATURE

DATE EMERGENCY CONTACT NAME:_________________________________CONTACT NUMBER:__________________________

FOR OFFICE USE ONLY (Applicants do not write below this line) APPROVED BY: _________________________________________DATE: __________________________ MONTHLY FEES: ______________________NUMBER OF CHILDREN ATTENDING: ___________________