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Al Tawheed Center © 2020

Weekend School Application

Step 1 of 6

Student Information
Name of the Student*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
Phone
Home Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother's Information
Mother's Name
First Last
Mobile*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Information
Father's Name
First Last
Mobile*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact
Emergency Contact Name
First Last
Mobile*
Email
Relationship to the Child

Level
Arabic Reading Level*
Islamic Studies Level*

Signatory Information
Signatory Name*
Signatory's Relationship to the Child
Consent*
I agree to the privacy policy.
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