Al-Huda Islamic School Registration Form

Please PRINT clearly and fill out the information on both sides

Child’s Information

Child #1:          __________________________________________ 

Date of Birth:  ______________  Age:   ________ 

Child #2:          __________________________________________ 

Date of Birth:  ______________  Age:   ________ 

Child #3:          __________________________________________ 

Date of Birth:  ______________  Age:   ________ 

Child #4:          __________________________________________ 

Date of Birth:  ______________  Age:   ________ 

Child #5:          __________________________________________ 

Date of Birth:  ______________  Age:   ________ 

**Food Allergies:  ________________________________________________________________________________

Parent Contact Information

Father’s Name:            _____________________________________________________________________________

Mother’s Name:            _____________________________________________________________________________

Home Phone Number:  ____________________________ 

Cell Phone Number:            ____________________________

**Email address:              ____________________________________________________________________________

Street Address:                        _____________________________________________________________________

City, State, Zip Code               _____________________________________________________________________

Things you need to know:

1. Cost:  $175 first child, $100 each additional child (tuition includes snack)- please make checks payable to IMRI (we accept donations to sponsor children)
2. Drop off  and pick up your child on time- if you are more than 10 minutes late, you will be required to stay at the school while your child is attending
3. A snack and drink will be provided by the school for your child
4. Read the policies and procedures of the Parent/Student Handbook

Emergency Contact Information

Full Name:            ____________________________________________________________________________

Phone Number:         _______________________       

Relationship to child:            _____________________

Boys’ Group Registration

In order to enroll your son in Boys’ Group, he must be between the ages of 7 and 12.

______     Yes, I would like to sign up my son(s)

______     No, I do not want to sign up my son(s)

Girls’ Group Registration

In order to enroll your daughter in Girls’ Group, she must be between the ages of 7 and 12.

_______  Yes, I would like to sign up my daughter(s)

_______  No, I do not want to sign up my daughter(s)

Things you need to know:

1.  Drop off your child promptly at activities
2. Please send lunch with your child when necessary
3. Pick up your child on time from activities

I understand the rules and regulations for Boys’/Girls’ Group and allow my child to participate in all activities. 

Date:     __________________     

Signature of parent/guardian:      _______________________

**Information about Boys’ & Girls’ Group will be sent through the masjid email list as well as your personal email address that you have provided above.**