Registration Form (2024-2025)

Parent / Guardian Name

Parent's Email Address

Primary Phone Number

Mother / Alternate phone number

WhatsApp Phone number (To add in Parents group & further communication)

Student's Name (as on Health card)

Student's Health Card Number

Student's Age (Please select the appropriate group)

Student's Date of Birth

Address

Please describe any allergic/seasonal reactions your child may suffer from or any other illness/special needs of which we should be aware ?

(This information will help us to make student’s learning a more enjoyable, and fulfilling experience, and will be held in the strictest confidence.)

Please explain if your kid have any allergies.

Class Timing and Days Selection

We have limited spots and specific days for the classes. Please pick either the Monday and Tuesday option or the Wednesday and Thursday option. Also, select a time so we can know how many kids are in each group.

Days Selection

Time Selection

Payment Information

If you wish to pay with a Debit or Credit card, please check this box.

If you wish to pay using a void cheque, please check this box.

Card Number

Card holder name

Expiration

CVV

Zip / Postal Code

Signature

Void Cheque' or 'Direct Deposit Form' for monthly payment registration.

Bank Name

Bank address

Transit Numer

Institution Number

Bank Account Number

Signature

Waiver: I hereby waive my right to make any claim against Management and Volunteers of MMCC, in case of any harm/injury to my son / daughter or loss of any valuable / belongings during attendance in class. I will assume full responsibility of compensation to MMCC for any damages to the property caused by my son / daughter. In the case of an emergency, I give permission to transport my son / daughter to a hospital for medical treatment.

Evening Islamic School

Registration Form (2024-2025)

Class Timing and Days Selection

Payment Information