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School - Application 2009 2010

The document is an enrollment application for Masjid Al Islam School for the 2009-2010 school year. It requests basic information about the child, including name, age, birthdate, grade completed, contact information for guardians, emergency contacts, health information, immunization records, medication, allergies, authorization for who can pick up the child from school, and a contract agreeing to tuition payment and academic standards. The application collects essential details to enroll a child in the school.

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Sister Sonia
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© Attribution Non-Commercial (BY-NC)
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132 views5 pages

School - Application 2009 2010

The document is an enrollment application for Masjid Al Islam School for the 2009-2010 school year. It requests basic information about the child, including name, age, birthdate, grade completed, contact information for guardians, emergency contacts, health information, immunization records, medication, allergies, authorization for who can pick up the child from school, and a contract agreeing to tuition payment and academic standards. The application collects essential details to enroll a child in the school.

Uploaded by

Sister Sonia
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Applications may be mailed to

MASJID AL ISLAM SCHOOL 8006 MacArthur


Blvd
“Educating Children for 16 years” Oakland,
Ca 94605

ENROLLMENT APPLICATION
2009-2010

Basic Information (complete an application for each child)

Child’s name Age

Child’s birth date Last grade completed

Guardian(s) enrolling the child

*Name Relationship to child

Address City zip


Home phone Alternate phone

Employer Work phone

*Name Relationship to child

Address City zip


Home phone Alternate phone

Employer Work phone

MAI Enrollment Application 1


Previous school attended

Name
Address `
City State
Phone
Dates attended

Emergency Information

Child’s Doctor Phone


Health Insurance Company Policy #

If the parents or guardian cannot be contacted in an


emergency, please contact:

*Name
Relationship to the child
Phone

*Name Relationship to the child

Phone

Health Information

Has the child had any of the following? (Please indicate month and year)

Chicken Pox Scarlet Fever Asthma

Measles Whooping Cough Diabetes


Mumps Pneumonia Eczema

MAI Enrollment Application 2


Rubella Rheumatism Epilepsy

Has your child been immunized? (Please attach copy of immunization


card).

Is the child taking medication for any on-going medical problem?


Does the child have any allergies?

Any illnesses?

Any special needs?

Other important medical information:

Authorization to leave MAI School


Premises
For my child’s safety, MAI School Staff can allow to
leave school with: (Child’s name)

Only me (parent or guardian)

Persons I have specified below.

MAI Enrollment Application 3


Name Relationship to the
child

PARENTS SIGNATURE DATE

MAI SCHOOL- PARENT


CONTRACT
I, agree to enroll my child(ren),
in Masjid Al Islam School beginning on .I have received
and will become familiar with the school handbook and agree to comply with
all rules and responsibilities stated in it.

I agree to pay tuition in the amount of $300/month for the first child
and $250.00 for each additional sibling. The fee for extended care is
$100.00. I know that by paying my child’s tuition in a timely fashion will
ensure payment stipends for the teachers, monthly utilities, supplies, books,
and long-term projects such as recreational equipment, portables, etc.
I understand that tuition is due on the 1st of every month and is late
after the 5th business day. (Please make sure you obtain a receipt for your
records). If I have not paid my tuition by the 6 th business day, I agree not to
send my child to school until I pay the amount due to MAI School.
I understand that my child must have and continue to maintain a grade
point average of 2.0. If my child drops below this level during the first
quarter he/she will be put on probation first, and if not improved by the
second quarter he/she will be dis-enrolled.
I also agree to give 2 weeks notice if I plan to remove my child from
school and understand that tuition will still be due once my child has
attended the 1st five day of the month.
There is an annual book fee in the amount of $80.00 (excluding
preschoolers), which will go towards books, workbooks and other related
classroom material need for my child.

MAI Enrollment Application 4


I have met with and discussed the above with the Educational Director:

Parent/Guardian signature Educational


Director
Dated:

MAI Enrollment Application 5

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