Student Registration Form Announcement In person registration starting Sunday August 11th from 11am to 2pm , Will also have another one on August 18 and August 25 , From 11am to 1pm 1 : Basic Information Student Full Name Student Address Student Cell Phone (if available) Student DOB : Student Gender : MaleFemale New Student? YesNo Current IILM Sunday School Grade Add 2nd Child ? YesNo Second Student Full Name Second Student Address Second Student Cell Phone (if available) Second Student DOB : Student Gender : MaleFemale New Student? YesNo Current IILM Sunday School Grade Add 3rd Child ? YesNo 3rd Student Full Name 3rd Student Address 3rd Student Cell Phone (if available) 3rd Student DOB : Student Gender : MaleFemale New Student? YesNo Current IILM Sunday School Grade Add 4th Child ? YesNo 4th Student Full Name 4th Student Address 4th Student Cell Phone (if available) 4th Student DOB : Student Gender : MaleFemale New Student? YesNo Current IILM Sunday School Grade 2 : Parent's Information Parent Email Father Name Mother Name Father Phone Number Mother Phone Number Will father participate in Parent / Teacher orgainzation ? YesNo Will mother participate in Parent / Teacher orgainzation ? YesNo 3: Health Related Information Does your child have any medical or food allergies? If so please explain all known allergies. Pediatrician / Doctor's Name Pediatrician / Doctor's Phone Emergency Contact Name (if different than parents or additional) : Emergency Contact Phone (if different than parents or additional) : 5: Payment Information Click Here to see fee structure Fees Structure Are you Teacher ? YesNo Please select the right option to pay fees. Child :1 , Fees Type:Semester , ($390.00)Child :1 , Fees Type: Yearly , ($715.00)Childs :2 , Fees Type: Semester , ($755.00)Childs :2 , Fees Type: Yearly ,($1380.00)Childs :3 , Fees Type: Semester , ($1095.00)Childs :3 , Fees Type: Yearly , ($1995.00)Childs :4 , Fees Type: Semester , ($1435.00)Childs :4 , Fees Type: Yearly , ($2610.00) Please select your payment method Pay with PayPal Important Liability Agreement The undersigned who is the parent or legal guardian of the above named student agrees to completely indemnify and for ever hold harmless all the teachers, administrators, executive committee members, and the general body members of the IILM Islamic Center and its Islamic School from all liabilities that may result from an accident or injury be it physical or mental, to the student as a result of attending the Islamic school of IILM. Important School Policy and Procedure Agreement By enrolling the above student at IILM Islamic School, the parent/guardian agrees to abide by all the rules and regulations set forth in the Policies and Procedures manual ratified by the IILM School board. Student's Parent/Guardian Full Name Date :
