Admission Registration - Al Manarat Heights Islamic School In Mississauga

English and Math Help Session Registration Form

Section A: Applicant’s Information

First Name*

Last Name*

Date of Birth*

Age*

Gender*

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Primary Phone Number*

Secondary Phone Number

Email Address*

Section B: Parent's/Guardian's Information

Parent 1

Last Name*

First Name*

Relationship*

Father

Mother

Guardian

Cell Phone*

Email*

Parent 2

Last Name

First Name

Relationship

Father

Mother

Guardian

Cell Phone

Section C: Emergency Contact Information

Emergency Contact Name*

First

Last

Relation with the Student*

Cell Phone*

Section D: Medical Information

Please list all medical conditions that may impact student's study at AlManarat Academy or that may require attention while you are on campus. If there are none, please enter N/A.*

Health Card Number*

Version Number*

Section E: Fee Information

Registration Fee: $300
Payment Method: Direct Deposit

Direct Deposit Information

Branch/Transit Number*

Institution Number*

Account Number*

Section F: Enrolment Agreement

MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT : Personal information on this form is collected under the legal authority of the Education Act, R.S.O. 1980, c.129 and Health Card Numbers Control Act, 1991. This information will be used for the purposes of: processing student registration, production of student databases, student placement and referrals, statistical and reporting requirements by the Ministry of Education, program to students, contacting parent(s), guardian(s), etc., in case of emergency, and the disclosure of health related information to the Medical Officer of Health. Questions regarding this collection and use of personal information should be directed to the Administration Office.

I take full responsibility to enroll my Child at Al Manarat Academy

I am financially responsible for his/her fees and expenses

PARENT'S / GUARDIAN'S SIGNATURE*

Date*

This field should be left blank