Part-Time Islamic School Registration

Part-Time Islamic School

A New and Unique Program

Weekday and Weekend Classes Available

Part Time Islamic School Registration

Step 1 of 5

Registration for(Required)

Parent/Guardian Full Name(Required)

First Last

Home Address(Required)

Street Address City State / Province / Region

Parent/Guardian Phone Number(Required)

Home Phone Number

If Applicable

Parent/Guardian Email(Required)

Emergency Contact Full Name(Required)

First Last

Emergency Contact Phone Number 1(Required)

Emergency Contact Phone Number 2(Required)

Relationship to Student(s)(Required)

During our program and activities, we sometimes take photos and videos of the children to share with the parents and occasionally post on social media. Please read the media consent below and choose one of the options that follow.

MEDIA CONSENT FORM AND RELEASE FOR MINORS

I hereby grant Al-Ihsan Educational Foundation (“Al-Ihsan”), and its agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of My Child, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any Al-Ihsan publication or on the Al-Ihsan social media/ websites, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless Al-Ihsan and its agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
THIS IS A RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING

CONSENT: We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above named child and do hereby give our/my consent without reservation to the foregoing on behalf of My Child.

NON-CONSENT

NON-CONSENT: We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above named child and do not hereby give our/my consent without reservation to the foregoing on behalf of My Child.

Electronic Signature(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your typed name is the legal equivalent of your physical signature on this application.

A significant portion of our Part Time Islamic School consists of both indoor and outdoor activities and sports. In order for our children to participate in these activities, we require that you please read the waiver below and include your electronic signature.

Outdoor Activities(Required)

I have read and understood the above and allow my child(ren) (those listed in step 2 of this form) to take part in the indoor and outdoor activities at Al-Ihsan and at Newton Elementary School.

Electronic Signature(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your typed name is the legal equivalent of your physical signature on this application.

Grand Total

Grand Monthly Total

Credit Card

Card Details

Cardholder Name

Part Time Islamic School Registration

During our program and activities, we sometimes take photos and videos of the children to share with the parents and occasionally post on social media. Please read the media consent below and choose one of the options that follow.

A significant portion of our Part Time Islamic School consists of both indoor and outdoor activities and sports. In order for our children to participate in these activities, we require that you please read the waiver below and include your electronic signature.

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