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: _____________