Student Registration Form

Texas School of Islamic Studies

(A Foundation of IATC)

4901 Diaz Ave, Fort Worth Texas 76107

1(888) 523-1990

FAMILY INFORMATION

ID No:

Father's First Name

Mother's First Name

Family/Last Name

Dad's Cell

Mom's Cell

WhatsApp#

Street Address

City

State/Zip

Are you a new family:

YesNo

I authorize Texas School of Islamic Studies (TSIS) to use photos of my child/children on Facebook, Twitter, Instagram, and other social media platforms:

YesNo

Can we give your Child(ren):

Tylenol or Ibuprofen

YesNo

Neosporin

YesNo

Emergency Contact Name and Number (Not Living with you):

Relationship to Child:

STUDENT'S INFORMATION

Name of Student	Date of Birth	Age of Child	Gender	School Grade	TSIS Grade	Arabic Level	Allergies

FEE INFORMATION

	FEE	REMARKS
REGISTRATION FEE	$50/Student	Must Pay for at Registration
TUITION FEE	$40/Student/Month $20 for August	Pay Minimum one Month at Registration
LATE FEE AFTER AUGUST 31st	$15/Student	Must Pay for at Registration

Payment Summary

Number of Students:

Registration Fee:$50.00

Tuition Fee:$60.00

Late Fee (if applicable):$0.00

Total Amount:$110.00

Signature

Parent's Signature:

Date:

Student Registration Form

Texas School of Islamic Studies

FAMILY INFORMATION

STUDENT'S INFORMATION

FEE INFORMATION

Payment Summary

Payment Period:

Signature