MADINAH
MASJID OF
The Islamic
Center Of
2180 Old Denton
Road , Carrollton , TX 75006
REGISTRATION AND ADMISSION FORM
PLEASE PRINT CLEARLY AND USE ADDITIONAL FORM FOR
MORE THAN THREE CHILDREN
BRING THE COMPLETED FORM IN THE OFFICE ALONG WITH APPLICABLE
FEE(S)
ADMISSION FOR (Please check the appropriate box) SUNDAY SCHOOL REGULAR MADRASSAH
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 the Islamic Center of Carrollton 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 on
time. If for 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: