Dar-ul-Imaan Institute – Program Registration for Kids Darulimaan Institute - Kids Registration Form Main School Registration Form Step 1 of 10 10% Student InformationPlease Provide Student information. Which program(s) are you enrolling your child in?*Which program(s) are you enrolling your child in? Programs Available:*Full time Islamic School: September 2024 to June 2025 ($450/month/child)Weekend School: Saturdays September 2024 - June 2025 ($100/month/child) Note: Please submit the form separately for each program if you wish to enroll your kid(s) into multiple programs Islamic preschool & Montessori is for ages 3-6. Weekend school is for ages 4-11. One time Registration fee : $50 for all programs. Please select Number of Children to be enrolled*OneTwoThreeYou can apply for up to three children using this one Application form. if number of children are greater than 3, please fill out for the remaining children in separate Application form.1st Child's Name*FirstLastDate of Birth* Health Card no*Gender*MaleFemale Student InformationPlease Provide 2nd Student information. 2nd Child's Name*FirstLastDate of Birth* Gender*MaleFemaleHealth Card no* Student InformationPlease Provide 3rd Student information. 3rd Child's Name*FirstLastDate of Birth* Gender*MaleFemaleHealth Card no* Parent / Guardian InformationPlease Provide student's Guardian information. Parent's / Guardian Name*Home Phone*Email*Work Phone*Street Address*City, province, postal code*More than one Guardian?*YesNo 2nd Guardian InformationPlease Provide student's 2nd Guardian information. Parent's / 2nd Guardian Name*Home Phone*Work Phone*Street Address*City, province, postal code* Alternative Emergency ContactsPlease Provide Alternative Primary Emergency Contact information. Primary Emergency ContactHome PhoneWork PhoneAddressCity, ST ZIP Code Alternative Emergency ContactsPlease Provide Alternative Secondary Emergency Contact information. Secondary Emergency ContactHome PhoneWork PhoneAddressCity, ST ZIP Code Medical InformationPlease Provide Student's Medical Information.Hospital/Clinic PreferencePhysician’s NamePhone NumberAllergies/Special Health Considerations I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.Parent’s/Guardian’s Signature*Date* I give permission for my child to go on field trips (if any). I release Darulimaan Institute and individuals from liability in case of accident during activities related to Weekend School, as long as normal safety procedures have been taken..Parent’s/Guardian’s Signature*Date* Total$0.00This total includes one time Registration fee and enrollment fee for the kids in the program(s) selected. Submit the form below and Pay fees on the next page. The registration will not be completed without the fee payment. NameThis field is for validation purposes and should be left unchanged.
