AL-ILM WEEKEND SCHOOL Registration Form

Name

*

Last Name

*

Occupation

Spouse Name

Spouse Occupation

Address

*

City

*

State

*

ZIP Code

*

Telephone

*

Email

*

2nd Email

Add First Student

STUDENT #1 INFORMATION

Student Name

:

*

Date of Birth

:

*

Sex

:

Male

Female *

Enrolled Last Year

:

Yes

No *

Student Medical Condition

:

Add Second Student

STUDENT #2 INFORMATION

Student Name

:

*

Date of Birth

:

*

Sex

:

Male

Female *

Enrolled Last Year

:

Yes

No *

Student Medical Condition

:

Add Third Student

STUDENT #3 INFORMATION

Student Name

:

*

Date of Birth

:

*

Sex

:

Male

Female *

Enrolled Last Year

:

Yes

No *

Student Medical Condition

:

Add Forth Student

STUDENT #4 INFORMATION

Student Name

:

*

Date of Birth

:

*

Sex

:

Male

Female *

Enrolled Last Year

:

Yes

No *

Student Medical Condition

:

Add Fifth Student

STUDENT #5 INFORMATION

Student Name

:

*

Date of Birth

:

*

Sex

:

Male

Female *

Enrolled Last Year

:

Yes

No *

Student Medical Condition

:

OPTION 1
Total Number of Students:
Per Year: Mandatory fee: Online Processing fee: Sub Total:
OPTION 2
Per Semester: Mandatory fee: Online Processing fee: Sub Total:

Select Option 1 Select Option 2

STUDENT #1 INFORMATION

STUDENT #2 INFORMATION

STUDENT #3 INFORMATION

STUDENT #4 INFORMATION

STUDENT #5 INFORMATION

ORDER TOTAL: