IVIS Classes Registration

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Please complete all required fields. Accurate information helps us provide the best experience for your child.

PROGRAM SELECTION

Select the program you are registering for

Nurturing faith.
Building knowledge.
Inspiring futures.

PARENT / GUARDIAN INFORMATION

Parent/Guardian Name

Relationship to Student(s)

Address

Home Phone

Cell Phone

EMERGENCY INFORMATION

Alternate Contact Name Relationship to Student(s) Cell Phone

STUDENT INFORMATION

Please provide information for up to 4 students.

Student 1

Full Name

Gender

Date of Birth

Behavioral Issues

Allergies and/or Other Health Issues

Student 2

Full Name

Gender

Date of Birth

Behavioral Issues

Allergies and/or Other Health Issues

Student 3

Full Name

Gender

Date of Birth

Behavioral Issues

Allergies and/or Other Health Issues

Student 4

Full Name

Gender

Date of Birth

Behavioral Issues

Allergies and/or Other Health Issues

AGREEMENT & SIGNATURE

Parent/Guardian Name (Print)

Parent/Guardian Signature

Date

Your completed form will be prepared for edu@daraltaqwa.org.

Zelle Payment to schools@daraltaqwa.org

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IVIS CLASSES

CLASS REGISTRATION

PROGRAM SELECTION

PARENT / GUARDIAN INFORMATION

EMERGENCY INFORMATION

STUDENT INFORMATION

AGREEMENT & SIGNATURE