Jafaria School New Student Registration Form
For Academic School Year 2017 - 2018


Registration for students during the 2017 - 2018 school year may be completed using the online enrollment form below.

Instructions:
Fill out the registration form completely and accurately. It is important that you provide a valid e-mail address for each parent who wishes to receive Engrade notifications. (If only providing information for one parent, please indicate N/A for the other parent's information.) Failure to provide complete and accurate information may result in delays in processing.

Minimum Requirements:
- The child must turn age 4 on or before October 31st of the year they are being registered for.
- The child must be potty trained.

Important:
If you are enrolling two or more children, you MUST click on the checkbox next to where it says "I am submitting a 2nd student", "I am submitting a 3rd student", "I am submitting a 4th student", and "I am submitting a 5th student", etc. respectively. Failure to do so may result in each additional child not being processed.

Upon submission of the form, you will receive an acknowledgement email that your enrollment form has been received.

Once your registration form has been reviewed and processed, you will then receive a subsequent email from the Jafaria School administration team notifying you that your registration has been confirmed, along with instructions on how to remit payment of the enrollment fees.

Please be advised that registration is on a first-come, first-serve basis, and that we have limited capacity available. If your registration is unable to be processed, you will be placed on a waiting list. Your registration is not confirmed until payment is made in full.

Enrollment Fee Schedule:
$450 for first child in the household
$350 for each additional child in the household

* ALL Fields marked with an asterisk (*) are REQUIRED.
** If a field does not apply, simply enter "NONE".


Parents Information


Father Information

Father's First Name *
Father's Middle Name
Father's Last Name *
Father's Mobile Number *
Father's E-mail Address *

Mother Information

Mother's First Name *
Mother's Middle Name
Mother's Last Name *
Mother's Mobile Number *
Mother's E-mail Address *

Residence Information

Street Address *
City *
State *
Zipcode *

Emergency Contact Information

First Name
Last Name
Mobile Number
E-mail Address
Street Address
City
State
Zipcode

Student #1

First Name *
Middle Name
Last Name *
Mobile Number (if any)
E-mail Address (if any)
Birthdate (MM-DD-YYYY) *
Gender * Male Female
What public school grade will your child be going into in September 2017? *

Student #1 Allergy Information

Does the student have any allergies? Yes No
Allergy Description

Student #1 Quran Assessment

Has your child finished reading the entire Quran in Arabic? Yes No
If yes, on what date?
Is your child currently taking Quran lessons elsewhere eg) Online, at another school, or with a private tutor? Yes No
If yes, with whom?
Does your child speak Arabic at home? Yes No

Student #1 Islamic School History

Has your child ever attended Jafaria School before? No Yes
If no, has your child ever attended an Islamic school elsewhere? Yes No
If yes, please list where.

Student #2

I am submitting a 2nd student. * You MUST select this checkbox if you are enrolling a second student, otherwise your 2nd child's registration will not be processed.
First Name
Middle Name
Last Name
Mobile Number (if any)
E-mail Address (if any)
Birthdate (MM-DD-YYYY)
Gender Male Female
What public school grade will your child be going into in September 2017?

Student #2 Allergy Information

Does the student have any allergies? Yes No
Allergy Description

Student #2 Quran Assessment

Has your child finished reading the entire Quran in Arabic? Yes No
If yes, on what date?
Is your child currently taking Quran lessons elsewhere eg) Online, at another school, or with a private tutor? Yes No
If yes, with whom?
Does your child speak Arabic at home? Yes No

Student #2 Islamic School History

Has your child ever attended Jafaria School before? No Yes
If no, has your child ever attended an Islamic school elsewhere? No Yes
If yes, please list where.

Student #3

I am submitting a 3rd student. * You MUST select this checkbox if you are enrolling a second student, otherwise your 3rd child's registration will not be processed.
First Name
Middle Name
Last Name
Mobile Number (if any)
E-mail Address (if any)
Birthdate (MM-DD-YYYY)
Gender Male Female
What public school grade will your child be going into in September 2017?

Student #3 Allergy Information

Does the student have any allergies? Yes No
Allergy Description

Student #3 Quran Assessment

Has your child finished reading the entire Quran in Arabic? Yes No
If yes, on what date?
Is your child currently taking Quran lessons elsewhere eg) Online, at another school, or with a private tutor? Yes No
If yes, with whom?
Does your child speak Arabic at home? Yes No

Student #3 Islamic School History

Has your child ever attended Jafaria School before? Yes No
If no, has your child ever attended an Islamic school elsewhere? Yes No
If yes, please list where.

Student #4

I am submitting a 4th student. * You MUST select this checkbox if you are enrolling a second student, otherwise your 4th child's registration will not be processed.
First Name
Middle Name
Last Name
Mobile Number (if any)
E-mail Address (if any)
Birthdate (MM-DD-YYYY)
Gender Male Female
What public school grade will your child be going into in September 2017?

Student #4 Allergy Information

Does the student have any allergies? Yes No
Allergy Description

Student #4 Quran Assessment

Has your child finished reading the entire Quran in Arabic? Yes No
If yes, on what date?
Is your child currently taking Quran lessons elsewhere eg) Online, at another school, or with a private tutor? Yes No
If yes, with whom?
Does your child speak Arabic at home? Yes No

Student #4 Islamic School History

Has your child ever attended Jafaria School before? Yes No
If no, has your child ever attended an Islamic school elsewhere? Yes No
If yes, please list where.

Student #5

I am submitting a 5th student. * You MUST select this checkbox if you are enrolling a second student, otherwise your 4th child's registration will not be processed.
First Name
Middle Name
Last Name
Mobile Number (if any)
E-mail Address (if any)
Birthdate (MM-DD-YYYY)
Gender Male Female
What public school grade will your child be going into in September 2017?

Student #5 Allergy Information

Does the student have any allergies? Yes No
Allergy Description

Student #5 Quran Assessment

Has your child finished reading the entire Quran in Arabic? Yes No
If yes, on what date?
Is your child currently taking Quran lessons elsewhere eg) Online, at another school, or with a private tutor? Yes No
If yes, with whom?
Does your child speak Arabic at home? Yes No

Student #5 Islamic School History

Has your child ever attended Jafaria School before? Yes No
If no, has your child ever attended an Islamic school elsewhere? Yes No
If yes, please list where.

Yearbook Consent

I consent to have my child's photographs included in the Jafaria School Yearbook. Yes No

Parent Teacher Organization (PTO)

Are you interested in joining the Jafaria School PTO? Yes No

Volunteer Sign-Up

Volunteer Information
Areas that you would be interesting in volunteering for the school:
(You may choose more than one.)
History Teacher
Fiqh Teacher
Akhlaq / Aqaid Teacher
Quran / Arabic Teacher
Substitute / Assistant Teacher
Class Parent
Information Technology
Administrative / Clerical
School Library
Lunch Volunteer
Facilities Management
School Store

Acknowledgement

I certify that I have read and agree to abide by the terms and conditions as specified in the Jafaria School Handbook and the Jafaria School Parent / Student Responsibilities Primer (Abridged Handbook). *
I understand that my registration is not final until payment is received in full. *