Madressa Registration Form

(Section A) Family Information

(Section B) FEES - ONLY fill this section if Paying Fees by Credit Card. DO NOT FILL this section if paying fees by cash or check.

If you will be paying fees by Cash or Check, please SKIP this section completely. DO NOT fill out anything. When you complete the form, please click 'SUBMIT' & on the next page click 'CONFIRM' order with a total of $0.00 & you are done!

If paying fees by credit card, After you fill the form, please click 'SUBMIT' at the end, you will be directed to an 'Order Summary' page where you will see your total. Please click on 'Check Out with PAYPAL'. This will take you to a PayPal page, where you can either login if you have a Paypal account, OR select 'Pay with Debit or Credit Card' and enter your credit card information.

The Fee amount for this school school year is as follows : Family of 4 Children=$500.00 / Family of 3 Children=$450.00 / Family of 2 Children=$400.00 / Family of 1 Child=$350.00 / If you would like to pay your fees by cash or check, PLEASE DO NOT fill out this section. Just continue to section C.

Please Select Number of children in your family. If you wish to donate any additional funds towards Madressa, please specify that in 'Additional Donation' (Click 'CALCULATE' to see your total amount due)  
(Click ONLY IF PAYING BY CC) Current Total: 
$0.00

(Section C) Student Information - Please Fill out information for EACH child you are registering.

1st Child's information

calendar

2nd Child's Information (Leave Blank if only 1 child)

calendar

3rd Child's Information (Leave Blank if only 2 children)

calendar

4th Child's Information (Leave Blank if only 3 children)

calendar

(Section D) Emergency Contacts - PLEASE provide 2 Emergency contacts who are NOT THE PARENTS

Emergency Contact 1 - MUST NOT BE THE PARENTS' INFORMATION

Emergency Contact 2 - MUST NOT BE THE PARENTS INFORMATION OR THE SAME AS THE FIRST EMERGENCY CONTACT

  
Secured by Formsite