Enrollment form Registration Form CLICK HERE TO GET MORE INFORMATION ON OUR MONTHLY TUITION FEES 1Registration Form 2Payment Student’s InformationFirst and Last Name:* First First and Last Name:* First Parent(s)/Guardian(s) Full Name(s):* 1. 2. (if applicable) Birth Date:* Mon Day Year Gender* Male Female Student's Grade in the Farsi School: K 1A 1B 2 3 4 5 6 Do you have another student? Yes No First and Last Name:* First First and Last Name:* First Birth Date:* MM DD YYYY Gender* Male Female Student's Grade in the Farsi School: K 1A 1B 2 3 4 5 6 Another studentFirst and Last Name:* First First and Last Name:* First Birth Date:* MM DD YYYY Gender* Male Female Student's Grade in the Farsi School: K 1A 1B 2 3 4 5 6 AddressAddress* Street Address City ZIP / Postal Code Home Phone:Cell Phone:*Contact InformationFIRST PARENT/GUARDIAN* Full Name Cell Phone*Home Phone*Relationship to student* First Email Address* Primary Language* First SECOND PARENT/GUARDIANFull nameRelationship to studentCell phoneHome phoneEmail addressPrimary languageEMERGENCY CONTACT (OTHER THAN PARENT)Full nameRelationship to studentCell phoneHome phoneEmail addressPrimary languageEmergency Medical InformationMedical Insurance:Insurance Policy #:Physician's Name:Physician's Office #:Does(do) your child(ren) have any food or medication allergies?* Yes No If you answered Yes, please specify:* I undersigned as parent or legal guardian of the above named student do hereby consent to release Avicenna Academy and all their officers, directors and agents from and against all claims, demands, liabilities, actions or causes of action of any sort, liquidated or unliquidated, past, present or future, which arise out of or relate to the classes being conducted including but not limited to physical activities such as sports, dance and etc. I hereby acknowledge that I am responsible for the tuition due to Avicenna Academy. I authorize Avicenna Academy to use photographs and/or videos of my child’s school sponsored activities and/or performances for the school’s purposes including the Avicenna Academy’s school yearbook, calendar, or other social media related to the school. I certify I have read and understood all the above items, and completed all the required fields * I have read and agree to the terms and conditions above.** I agree with Rules and Regulations of Avicenna Academy*Please Print Name:* First Date:* Month Day Year Signature of Parent/Guardian:*you can renew your signature by clicking on the right corner of the icon Dear Parent(s)/Guardian(s), please note the following: There is a one-time $50 registration fee per student enrolled Monthly tuition fee is due on the first calendar day of each month. There will be a $15 late fee if the tuition is not paid by the 5th of each month. If tuition is not paid by the 10th of the month, the student should re-register and pay the registration fee. Please let our staff know if you have financial situations, your family might be eligible for our discount program. The financial commitments by the school are met by the tuitions you pay, therefore please follow the described rules, we thank you very much for your cooperation. * I agree with Tuition and Registration Policy of Avicenna Academy*