Enrollment

"Lighting a Pathway to 21st-Century Leadership Through Academic and Moral Excellence"


Additional documents for registration

Bring this registration form and the following documentation to the school office.

  • Original Certified Birth Certificate
  • Current Immunization Form
  • Recent Report Card, or Student Records

Student Information


    First Name
    Last Name
    M.I.


    Have you previously applied to or attended this school?
    If yes, what year?

    Current Residence Information

    Street Address
    Street Address Line 2

    Parent/Guardian Residence Information (if different from above)

    Parent or Guardian Name

    Street Address
    Street Address Line 2

    Emergency Contact 1

    First Name
    Last Name
    Primary Phone Number
    Secondary Phone Number

    Emergency Contact 2

    First Name
    Last Name
    Primary Phone Number
    Secondary Phone Number

    Physician and Medical Information

    First Name
    Last Name
    Primary Phone Number
    Secondary Phone Number
    Preferred Hospital
    Insurance/Health Coverage (Company)
    Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health conditions.

    Enrollment History


    Previous School 1

    School Name
    City
    State

    Previous School 2

    School Name
    City
    State

    Tell us about your child

    What do You feel are your child's talents, abilities and any challenges he/she may have?
    List any awards, achievements and or extra curricular activity that your child is involved in.
    Does your child currently have one of the following?
    Any additional information that you would like to tell us about your child.

    Tell Us About You

    Mother or Guardian Occupation
    Father or Guardian Occupation
    Please list any expertise or talents you can volunteer to the school to fulfill parent hours.
    Child is currently living in home with:
    How do you think your child(ren) will benefit from an Islamic education?