2 Students Form

Student-1

Student-1 First name

Student-1 Last name

Student-1 Gender

Male

Female

Student-1 Birthday

Month

Day

Year

Expected school grade for Fall 2025 (in Public School)

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Student-2

Student-2 First name

Student-2 Last name

Student-2 Gender

Male

Female

Student-2 Birthday

Month

Day

Year

Expected school grade for Fall 2025 (in Public School)

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Parents info

Mother’s first and last name:

Mother’s phone:

Mother’s email:

Father’s first and last name:

Father’s phone:

Father’s email:

Consent & Enrollment Agreement

Please carefully read the following consent and policies for your child’s enrollment at Mind Builders Islamic Academy, The Sunday School.

Authorization of Consent to Treatment of a Minor

I/we authorize Mind Builders Islamic Academy, The Sunday School, to consent to any necessary medical treatment for my/our child under the care of a licensed physician or hospital, as deemed advisable in an emergency. This authorization remains valid for the academic year (September–June), unless revoked in writing.

Enrollment Policy

The school reserves the right to dismiss a student if attendance falls below 60% or if conduct is detrimental to the welfare of the school.

Payment Policy

Tuition is due for the full academic year, payable in full in September or in two installments (September & January).
Limited financial assistance is available on a first-come, first-served basis.

Liability Release

I/we permit my/our child to participate in all school activities, including sports and field trips.
I/we release Mind Builders Islamic Academy, its staff, and affiliates from liability for injury or damages during school activities.
I/we accept the school’s mission, policies, and standards of discipline.
I/we will notify the school promptly of any changes in contact information.

Does your child have any special needs?

Yes

I give permission to take photographs and/or video of my child to be used for the school’s website, social media account, etc., or during community events?

Yes

Anything the school/teacher needs to know about your child: (please include Emergency Information)

I have read and agree to the Consent & Enrollment Agreement above.