Welcome to Ansaar Academy of Inland Empire

Student Details

Applying For (select 1 or more) *

Student Details

If you are enrolling more than 1 students, please complete this form for each student.

Full Name *

Date of Birth *

Gender * Male Female

Does your child have any previous experience at another Islamic School? If so, what is the name of that school and how long did they attend ? *

What is your child's current grade level in school (K through 12)? *

Parent Details

Parent/Guardian Information

Please complete this section entirely.

1st Parent Name *

1st Parent/Guardian Role * Mother Father Legal Guardian

1st Parent E-Mail *

1st Parent Cell Phone *

Work or Additional Phone # *

Home Address *

Street Address *

City *

State / Province / Region *

Postal / Zip Code *

Country *

2nd Parent Name *

2nd Parent/Guardian Role Mother Father Legal Guardian

2nd Parent Cell Phone

Emergency Contact

Emergency Contact Person (if parents unavailable) *

Emergency Contact Phone # *

Please describe any food alergies we should be aware of, if any. *

Please describe any medical or health conditions we should be aware of relating to your child, if any. *

Does your child have any special needs or disability needs ? If yes, explain. If not say No *

Agreement & Signature

Release of Liability and Assumption of Risk

Please read the following carefully before signing and submitting this form.

I, on behalf of my minor child/children hereby waive in advance any and all actions or claims of injury or property damage which may occur as a result of my child/children participating in any activity or activities sponsored by Ansaar Academy. I hereby release and hold harmless the Inland Empire Community Wakf, the Islamic Center of Inland Empire, Ansaar Academy and the officials, employees, volunteers, and agents of these organizations. *

I accept

I permit the taking of photographs of themselves and or minor children by the Islamic Center of Inland Empire and Ansaar Academy during the activities. *

I accept

I permit off-site field activities when notified in advance. *

I accept

I am aware that Parents are responsible for reading the school booklet. *

I will read the online booklet

I will pick up a copy from the office

Use your touchscreen or mouse to draw your signature into the box below. *

I understand this is a legal representation of my signature.

Spam Protection. Please answer this simple question. *

Review your entry

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Applying For (select 1 or more)

Student Details

If you are enrolling more than 1 students, please complete this form for each student.

Full Name

Date of Birth

Gender

Does your child have any previous experience at another Islamic School? If so, what is the name of that school and how long did they attend ?

What is your child current grade level in school (K through 12)?

1st Parent Name

1st Parent/Guardian Role

Father

1st Parent E-Mail

1st Parent Cell Phone

Home Address

2nd Parent Name

2nd Parent/Guardian Role

Father

2nd Parent Cell Phone

Emergency Contact Person (if parents unavailable)

Emergency Contact Phone #

Please describe any food alergies we should be aware of, if any.

Please describe any medical or health conditions we should be aware of relating to your child, if any.

Does your child have any special needs or disability needs ? If yes, explain. If not say No

Release of Liability and Assumption of Risk

Please read the following carefully before signing and submitting this form.

I accept

I permit the taking of photographs of themselves and or minor children by the Islamic Center of Inland Empire and Ansaar Academy during the activities.

I accept

I permit off-site field activities when notified in advance.

I accept

I am aware that Parents are responsible for reading the school booklet.

Signature.

Your signature will go here!

Registration

Ansaar Academy Student Registration

Student Details

Parent Details

Emergency Contact

Agreement & Signature

Review your entry