Al-Fatemah Islamic Center - Sunday Islamic School

P.O Box 1325 Guilderland, New York 12084

Student Registration Form

Father’s Name: ____________________ Mother’s Name: ___________________

Address: ___________________________________________________________

City: _______________________________ State: ______ Zip: _______________

Home Phone:_________________________ Cell Phone: ____________________

Student Information: Fill one for each child

1). First Name:__________________________ Last: ________________________

Date Of Birth: ____________ (M/D/Y)  Gender: Male:______  Female: _______

             School Grade for 2008-2009: KG, 1, 2, 3, 4, 5, 6, 7, 8, 9. (circle one)

2). First Name:__________________________ Last: ________________________

             Date Of Birth: ____________ (M/D/Y)  Gender: Male:______  Female: _______

             School Grade for 2008-2009: KG, 1, 2, 3, 4, 5, 6, 7, 8, 9. (circle one)

3). First Name:__________________________ Last: ________________________

             Date Of Birth: ____________ (M/D/Y)  Gender: Male:______  Female: _______

             School Grade for 2008-2009: KG, 1, 2, 3, 4, 5, 6, 7, 8, 9. (circle one)

4). First Name:_________________________ Last: _________________________

             Date Of Birth: ____________ (M/D/Y)  Gender: Male:______  Female: _______

             School Grade for 2008-2009: KG, 1, 2, 3, 4, 5, 6, 7, 8, 9. (circle one)

Permissions:

• Al-Fatemah Islamic Center - Sunday Islamic School will be compiling a phone book. Your phone number will be given to Al- Fatemah teachers to inform you about important information related to the Islamic School.

            Include my name and phone number as part of the phone tree:   Yes      No

• Al-Fatemah Islamic Center - Sunday Islamic School as part of the school activities will take pictures of students for our bulletin board and other activities.

            I give permission to include my child’s picture:                           Yes      No

Please review the following dress code and attendance policies:

          • All students attending the Islamic school and its events are required                to adhere to proper Islamic dress code.

          • Regular attendance and punctuality are required. The assembly                      preceding classes and salaat following classes are both part of the                weekly school session and barring exceptional cases, students must                     attend this entire school session.

As parent/guardian of the student whose name appears above, I hereby release and waive any claim against Al-Fatemah Islamic Center - Sunday Islamic School and its officers, directors, teachers, and volunteers for any damage or injury suffered by the students on account of or in connection with the student’s participation in school related activities. This Waiver and Release of Liability shall operate as a complete waiver and release for any personal

injury , missing person, death, and waiver of property or other damage or loss, including loss of use, which may arise in connection with the student’s participation in the school related activity. I acknowledge that I am aware of the risks associated with the school related activities, whether the

risks are by reason of preparation for participation, transportation of the students, exposing the students to the elements and to general public, or otherwise exposing the students to risks which may or may not be generally associated with the school related activities.

I also agree to adhere to the dress code policy and other general policies of Al-Fatemah Islamic Center - Sunday Islamic School to the best of my abilities.

Parent/Guardian Name: (please print)_______________________________

Signature: __________________________Date:___________