ANNUR ISLAMIC SCHOOL

Basic Information

First Name *

Last Name *

Date Of Birth*

Gender *

Grade *

Contact Information

Student's UserName *

Mobile Phone

ZipCode *

Country*

State*

City *

Address *

Guardian Information

Dear Parent/Guardian, If your any child is already Enrolled in AnNur Islamic School then Kindly Use Same Email.

Enter Parent Email*

First Name *

Last Name *

Mobile No *

Upload Additional Document

Emergency Information

AIS must have the following important information on file.
Please notify the school immediately if any of the information changes. Please Print Clearly

Student Information

Student Address

Home#

Father/Guardian Information

Father’s Name *

Email Address *

Father’s Cell#

Father’s Work#

Mother/Guardian Information

Mother’s Name *

Email Address *

Mother’s Cell#

Mother’s Work#

Other Information

Please list two OTHER emergency contacts that have your permission to pick up your child:

1st Person Info

Name *

Relationship to child *

Phone#

2nd Person Info

Name *

Relationship to child *

Phone#

Family Doctor Information

Family Doctor *

Phone#

Insurance Carrier *

ID#

Parent/Guardian: Complete this section only.

I give permission for the exchange of information concerning my child *

between AnNur Islamic School and *

Name of Parent/Guardian *

Date

ITEMS REQUESTED

Student Transcript

Current Report Card

Standardized Test Score (i.g. TerraNova, CATS, MATS, State Tests, IOWA, etc.)

Cumulative Health Records

Psychological Folder

Special Education Records (including most recent IEPs)

Other

In addition to the uploading of the medical form please bring/mail the original copy to the office as well.

Age*

School *

Grade Entering *

Pediatrician

Phone number *

Preferred hospital *

Dentist *

Phone number *

Please check below if your doctor ever said your child had problems with any of the following:

Asthma/Breathing
Bleeding
Headaches
Heart condition
Kidney condition
Nose bleeds
Painful joints
Skin condition
Stomach/Bowel
Urinary condition

Broken bones
Cancer
Chicken Pox
Diabetes
Head Injury/Concussion
Meningitis
Pneumonia
Rheumatic Fever
Tuberculosis
Whooping Cough

Behavior Problems
Cavities/dental problems
Ear infections/tubes
Facial tics
Hearing Problems
Problems running/walking
Speech difficulties
Surgery
Vision Problems
Seizure Disorder

If you checked any boxes above, please explain *

Is your child receiving medication for any of the above conditions? *

If yes, drug, dosage and frequency *

Has your child ever had an allergy evaluation by a specialist? (If yes, give date)

Allergies: Please specify agent or food (ex. Bee sting) *

Will your child need medication to be administered in school? *

Has your child ever been hospitalized since birth? *

Any other information you wish to share *

Name *

Relationship to child *

Check List

Filled out Complete application Form
Medical Form
Current Medical Record
Birth Certificates
Transcript Form
Textbook Form
Registration and Service Fee
School Tuition
Parent/Student Handbook
Transportation Form
Special Education Services Application only if applicable

In an effort to avoid unnecessary additional fee for missing textbooks, parents will be responsible to collect their child’s textbooks and workbooks directly from their school district office. Please make sure your child returns this year’s school textbooks to AIS office before or on June 1st, in order to claim next year’s.

admission

Fee Schedule, Uniform and Classroom Supply List

Steps for registration:

Basic Information

Contact Information

Guardian Information

Upload Additional Document

Emergency Information

Student Information

Father/Guardian Information

Mother/Guardian Information

Other Information

Please list two OTHER emergency contacts that have your permission to pick up your child:

1st Person Info

2nd Person Info

Family Doctor Information

In addition to the uploading of the medical form please bring/mail the original copy to the office as well.

Please check below if your doctor ever said your child had problems with any of the following:

Check List

Information Message!

Subscription Successfull!

Operation Failed!

Operation Failed!

Information Message!

Information Message!

Operation Failed!

Operation Failed!

User Exist!

Email Exist!

Successful!

Successful!

Successful!

Operation Failed!

Operation Failed!

Successful!

Successful!

Operation Failed!

Successful!