DarulArqam

Please complete each item carefully

SECTION A

Must complete for each child

Student's Name*

Birth Place*

Current Level*

Student's Social Security

Gender*

Home Language*

Birth Date*

SECTION B

Completing for one child can suffice for others The following information is exactly SAME AS mentioned on the application of my following child:*

Father/Guardian Details

Legal Name*

Place of Employment*

Business Telephone

E-mail Address

Mobile*

Skills Father can volunteer to Darularqam

Mother/Guardian Details

Legal Name*

Place of Employment

Business Telephone

E-mail Address

Mobile

Skills Mother can volunteer to Darularqam

Home Address

Street*

State*

Apt#*

Zip code*

City*

Home Telephone Number*

My child may be released to the following person(s) only (Student will NOT be released to any other person without written authorization)

Name

Relationship to Student

Phone

SECTION C

Health Information

List health conditions, such as heart disease, diabetes, seizures, asthma, severe food or drug allergies, eye/ear problems, chronic illness, etc. and any medications the student takes:

I hereby

give do not give my consent for my child to be transported and supervised by staff on field trips and all school functions

give do not give my consent for my name, address and phone number to appear in the school year book and directories

give do not give my consent for Darularqam to take pictures of my child for advertising/ fundraising or any other activities

In the event my child becomes ill or is injured at school and I cannot be reached, IANT Quranic Academy is authorized to contact the person(s) listed above, or take my child to the physician indicated, or to a hospital and is given consent for emergency care depending on the severity of the illness or injury. The Academy is NOT financially responsible for any emergency care and/or transportation. Signature below signifies compliance with all Academy policies and procedures

Please check this box in lieu of signature if you are submitting this form electronically indicating you agree to waive formal signature

Please Complete

I understand that Darularqam does not fill the available seats by a first come first serve basis but according to merit. I understand that Darularqam reserves the right to decline an application due to tardiness or failure to show for a scheduled test, observation, or interview.

I understand and agree to the Darularqam admission process.

Prospective Student Name*

Please check this box in lieu of signature if you are submitting this form electronically indicating you agree to waive formal signature

Please complete each item carefully

Admissions

Events

Quick Link

Application

Please complete each item carefully

Admissions

Events

Quick Link