MAS QI 2016-2017 Registration Information

Asslamu Alaikum Dear MAS QI Parents,

Welcome to MAS-UC QI 2016-2017 school year, please make sure to take your time to read the attached document below and to correctly fill out the following form. Online Registration will only be accepted if completely filled out. By submitting this form, you are agreeing to the bylaws of the MAS QI AND the attached document below.

MAS-UC-QI-2016-2017-Registration Form

Students' Information

	First Name	Middle Name	Last Name	Grade	DOB	Gender	Allergies
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6

Home Phone*

Area CodePhone Number

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Father's Name

First NameLast Name

Father's Phone Number

Area CodePhone Number

Father's E-mail

Father's Occupation

Mother's Name

First NameLast Name

Mother's Phone Number

Area CodePhone Number

Mother's E-mail

Mother's Occupation

Do the parents live together?*

YesNo

Are the parents divorced?*

YesNo

If children do not live with parents,

Guardian's Name

First NameLast Name

Guardian's Phone Number

Area CodePhone Number

Emergency Contacts

Please list names and phone numbers of three people other than the parents to be contacted in case of an emergency. The emergency contacts will be contacted in a case where the parents cannot be reached or when the parents do not show up to take the child home on time. The emergency contacts are allowed to take the students with them in case the parents cannot be reached.

	Name	Relationship to Student	Phone Number
1
2
3

Please keep this information up-to- date with the teachers and the office staff. If any day for any reason you or your emergency contacts are unable to pick up your child, please let the teachers and the office staff know in writing the date and the name of the person who is taking the child home that day. The school staff has the right to ask the emergency person for a personal ID and to make a copy of it.

Health information is a very important. Please be sure to inform the teacher and the office staff of any specific health needs or information about your child. Enclose any relevant medical papers with this form to keep in the child’s folder. MAS-UC QI is not responsible for any medical problem that we were not informed about and was not confirmed in writing.

Please list any allergies or medical information necessary for the school to know.

To complete the form, acknowledge that you agree to the following rules by checking "Agree" below. You cannot submit the form without checking all of the boxes.

I authorize MAS UC QI Staff to provide my child with any Emergency Medical Care, including transferring him/her to a nearby emergency facility, when I cannot be reached. I will be responsible for the medical charges.*

Agree

I authorize MAS UC QI Staff to take my child to short trips using their private cars.*

Agree

I authorize MAS UC QI Staff to photograph or videotape my child in any school activities and to use photographs and videos in school presentations and other activities. If you do not want your child to be photographed, please share that with your child's teacher at the beginning of the school year.

Agree

Tuition is payable on due dates mentioned in the PDf file attached according to the payment plan each family will select. A late fee of $10 will be applied after the 15thof the month the payment is due. This money is not refundable.*

Agree

Tuition can be paid by checks payable to MAS; there is a charge of $30 for any check that bounces.*

Agree

Failing to pay tuition on time, without excuse or arrangement with the School Treasurer and the approval of the principal, will give MAS-UC QI the right to stop the child from attending the program, exclude the child from graduation ceremonies, hold the report card, and not re-register the child or siblings for the following school year.*

Agree

There are no tuition deductions for holidays, breaks or weather-related off days.*

Agree

There shall be no tuition deductions made due to the child’s absence, regardless of the reason (illness, family vacations, personal obligations or other reasons not specified herein). There shall be no tuition deductions made due to the child’s absence, regardless of the reason (illness, family vacations, personal obligations or other reasons not specified herein).*

Agree

A thirty (30) day written notice of the intent to withdraw you child from MAS-UC QI is required. If the notice is not provided, you will be liable for that quarter’s tuition. *

Agree

Each family is required to give a minimum of 5 hours in volunteer time for the service of the school. This service may include, but is not limited to, the following activities: chaperoning for field trips, substitute teaching when qualified, helping out during the school day, creating/providing class supplies, etc.*

Agree

Registration Fee

Registration Fee$15.00

# of students

By submitting this form, you are providing your virtual signature that all the information on this form is correct AND that you agree to the document attached above.