Az-Zahra Islamic School

2023-2024 Madressa / Sunday School Registration Form

(Section A) Family Information

Mother's Last Name *

Mother's First Name *

Father's Last Name *

Father's First Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mother's Cell Phone * 🛈

Father's Cell Number * 🛈

Home Phone # 🛈

Father's Email *

Re-Type Father's Email to confirm *

Mother's Email *

Re-Type Mother's Email to confirm *

NOTE: If you a prefer to pay the fees by Venmo, Cash or Check ...

AFTER COMPLETING the entire form, (minus Section B) Click 'CONTINUE' on the bottom;
On the next page you will see an order total of $0.00.
Click 'CONFIRM ORDER' ...
You are DONE and may send your fees as below:

by VENMO send to: @az-zahra-school-nj

by Check: Make Payable to 'Az-Zahra School'
Mail to: Az-Zahra School c/o Salma Ladak
180 Grand Avenue, Park Ridge, NJ 07656
OR give to Sis Salma Ladak or Br. Ali Panjwani in person
by Cash ; Please give to Sis Salma Ladak or Br. Ali Panjwani in Person

If paying Fees by PayPal or Credit Card...
Select the number of children registering, then click 'calculate' ; Complete the rest of the form.

Click 'CONTINUE' - at the bottom of the form.
You will be directed to the 'Order Summary' page where you will see your total.
Click on 'Check Out with PAYPAL'.

This will take you to a PayPal Checkout page, where you can login if you have a Paypal account,
OR select 'Pay with Debit or Credit Card' where you can enter your credit card information.
Note: (You do NOT NEED to have a PayPal account to use this feature)

(SECTION B) - SKIP if paying by Venmo, Cash or Check
The Fees amount for the 2023/2024 school year is as follows:
Family of 5 Children & More = $500.00 / Family of 4 Children=$450.00 / Family of 3 Children=$400.00 / Family of 2 Children=$350.00 / Family of 1 Child=$300.00

If paying fees by Venmo, Cash or Check ... SKIP THIS SECTION & PROCEED to Section C ; Student Information

If Paying by Credit Card or PayPal. ; Select The Number of children in your family below.

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 (DO NOT CLICK if paying by Venmo, Cash or Check)

🛈

Additional Donations

(Click 'CALCULATE' ONLY if paying by PayPal/CC Online) 🛈

$0.00

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

1st Child's Information

1st Child-First Name *

1st Child-Last Name *

1st Child-Date of Birth * +

1st Child - Allergies or Any Medical info including any Special Needs we should know about ; DO NOT LEAVE BLANK Type 'NONE" if None. * 🛈

1st Child-Email address if any

1st Child-Cell Phone # if any

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

2nd Child-First Name

2nd Child-Last Name

2nd Child-Date of Birth +

2nd Child - Allergies or Any Medical info including any Special Needs we should know about ; DO NOT LEAVE BLANK Type 'NONE" if None. 🛈

2nd Child-Email address if any

2nd Child-Cell Phone # if any

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

3rd Child-First Name

3rd Child-Last Name

3rd Child-Date of Birth +

3rd Child - Allergies or Any Medical info including any Special Needs we should know about ; DO NOT LEAVE BLANK Type 'NONE" if None. 🛈

3rd Child-Email address if any

3rd Child-Cell Phone # if any

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

4th Child-First Name

4th Child-Last Name

4th Child-Date of Birth +

4th Child - Allergies or Any Medical info including any Special Needs we should know about ; DO NOT LEAVE BLANK Type 'NONE" if None. 🛈

4th Child-Email address if any

4th Child-Cell Phone # if any

(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 OR THE SAME AS the 2nd Emergency Contact

Last Name (Emergency Contact 1) * 🛈

First Name (Emergency Contact 1) *

Cell Phone * 🛈

Emergency Contact 2 - MUST NOT BE The Parents Information OR THE SAME AS the 1st Emergency Contact

Last Name (Emergency Contact 2) *

First Name (Emergency Contact 2) *