Make your own free website on Tripod.com
Print this form out and mail to:

MADINA ACADEMY

One Madina Drive, P.O. Box 624, Windsor, CT. 06095

(860) 524-9700

REGISTRATION FORM

If you are interested in sending your child to Madina Academy please provide us with the following information. Submit your completed form by mail or return it to the Masjid (Drop Box).


Fatherís Last Name First Name


Motherís Last Name First Name


Street Address


Town/City State Zip Code


Telephone: Home Office


Childís Last Name First Name


Childís Date Of Birth Male / Female

 

Has the child previously attended a school? Yes / No

 

If yes, please state the name of the school:

 


If yes, what grade level has the child completed?

 

In which grade do you plan to enroll your child? Kindergarten / Grade 1 / Grade 2 / Grade 3.

Please note that financial assistance is available for families who are having difficulty in paying the fees.