Az-Zahra Islamic School Registration Form

(Section A) Family Information

(Section B) FEES - Fill this section only if Paying Fees by Credit Card

If paying fees by cash or check proceed to Section C - When you complete the form, click 'SUBMIT' ; On the next page you will see an order total of $0.00. Click 'CONFIRM' - You are done registering. You may pay your fees in person on Opening Day.

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

The Reduced Fees amount for this school school year is as follows : Family of 4 Children=$400.00 / Family of 3 Children=$350.00 / Family of 2 Children=$300.00 / Family of 1 Child=$250.00 / If you would like to pay your fees by cash or check, PLEASE DO NOT fill out this section. Just continue to section C.

(ONLY If Paying by CC) Select The Number of children in your family. If you wish to donate any additional funds towards Madressa, please specify the amount in 'Additional Donation' (Click 'CALCULATE' to see your total amount due)  
(Click 'CALCULATE' ONLY if paying by CC) 
$0.00

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

1st Child's information

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

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

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

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(Section D) Emergency Contacts - PLEASE provide 2 Emergency contacts who are NOT LIVING IN THE SAME HOUSEHOLD AS CHILD

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

Az-Zahra Tripartite Agreement ; & Other Policy & Procedures Acknowledgement

I have Read, Understood & Accept the Az-Zahra Tripartite Agreement ; Attendance Policy ; Dress Code ; Akhlaq Policy & Anti Bullying Policy set by Az-Zahra Islamic School and Pledge to follow them. (Also Available to view & download on website www.azzahraschool.org)  
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