The following form must be completed before your application will be considered. Please complete each item carefully.

Step 1 of 6

Student Information

First Name *

Middle Name

Last Name *

Email Address *

Age *

Date of Birth *

Home Phone *

Gender *

Male

Female

Address *

Apt/Unit

City *

State *

Zip Code *

Enrollment Type *

Currently Enrolled at DarulArqam? *

Yes

Please note that the child will be tested by Hifz teacher before enrolling in the program.
The parents will be responsible to make sure that the child is getting adequate secular education while the child memorizes the quran.

Grade Entering *

Parent Information

Parent/Guardian 1

Parent/Guardian Name *

Relationship *

Parent/Guardian Level of Education *

No of working hours per week *

Working Status *

Email Address *

Cell Phone *

Street Address *

Apt/Unit

City *

State *

Zip Code *

Parent/Guardian 2

Parent/Guardian Name

Relationship

Parent/Guardian Level of Education

No of working hours per week

Working Status

Email Address

Cell Phone

Street Address

Apt/Unit

City

State

Zip Code

Emergency Contact Information

Emergency Contact Name *

Relationship *

Email Address *

Cell Phone *

Street Address *

Apt/Unit

City *

State *

Zip Code *

Parent/Guardian Consent

Parent / Guardian of

will abide by the following conditions for admission:

1. All the information I have provided in the Dawah Academy Registration Form is true and correct to the best of my knowledge.

2. I agree to pay tuition and other fee per payment by 5th of every month.

3. I will be responsible for any damage caused to Dawah Academy property by my child and will compensate or replace the damage with an equal value and quality.

4. I agree to follow and respect the Dawah Academy rules and regulations and explain them to my child who attends the Dawah Academy. I understand that I am responsible for disciplining my child in case of violation of any Dawah Academy rules, in conduct and/or academics. I understand that if any problem occurs, I will completely and fully accept the decision of Dawah Academy Administration.

5. I give Dawah Academy Administration the authority to take necessary decisions to ensure my child safety and well-being when in their care. I give my child permission to participate in all activities deemed appropriate by Dawah Academy

6. I understand my child will be taken on field trips with my written consent.

7. I understand that the school will take any necessary action during an emergency.

8. I indemnify Dawah Academy from any legal liability whatsoever.

Parent / Guardian Name *

Tuition Fee Structure

Tuition fee is $75 per month per child. It will be electronically debited on the 5th of each month.
One time books fee of $30 per child will be charged in the first month.
Please contact admission office if you would like to apply for tuition assistance(zakat).

Tuition ACH Authorization Form

Account Holder's Information

First Name *

Middle Name

Last Name *

Address *

Apt/Unit

City *

State *

Zip Code *

Electronic Check Withdrawal Information

Type of Account *

Bank Name *

Bank Routing # *

Bank Account # *

Tuition Fee Structure

I hereby authorize Dawah Academy to initiate debit entries to the checking/savings account indicated above at the Financial Institution named, in the amount of the payment due and to make the deduction payable to Dawah Academy. A record of each ACH transaction will be included in my regular bank statement and will serve as my receipt. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U. S. law. Any returned ACH payments will be charged a $25 service fee, which will be billed to you on your students’ monthly incidental billing. This payment plan is to remain in effect until the payment plan ends or is cancelled by the participant in writing within at least five business days before the next scheduled withdrawal date. The participant may terminate the agreement at any time by submitting written notice to the Dawah Academy Center of Excellence Business Office. Termination from the agreement on the family’s part will not release the family of any financial obligation to the school. Questions or concerns regarding any of these terms and conditions should be directed to the Office at 612-758-0501.

Agree to Terms & Conditions

Parent / Guardian Name *

Student Information

Parent Information

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

Parent/Guardian Consent

Tuition Fee Structure

Tuition ACH Authorization Form

Account Holder's Information

Electronic Check Withdrawal Information

Tuition Fee Structure

Contact

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