Please fill in the information below and we will contact you to get more details and answer questions in shaa Allah.

For more information 708-888-7072

Registration and Tuition Rules

I, the undersigned, agree to the terms above.

Child information

Status

Program Options

Child's Name

Child's Name in Arabic

Date of Birth

Gender

Male
Female

Address

Does your child attend other programs?

If yes, please write the name of the program

Number of sibling’s child has

Do they attend MAS programs?

Terms

Please be thorough and specific about your child. Failure to do that will give MAS QURAN Institute (“MQI”) the right to expel the student and keep all the fees. Students will be accepted on probation for six weeks before they are officially accepted. Throughout the six week period, students will be supervised and evaluated.

I, the undersigned, agree to the terms above.

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. MQI is not responsible for any medical problem that we were not informed about and was not confirmed in writing.

I have read and agree to the terms above.

Does your child have any food allergies

If yes, please explain

Pediatrician’s Name

Phone Number

Medical Condition Information

Health information is very important. Please complete the following about your child’s health. Reasonable steps will be taken to keep this information confidential, however, it will be shared with staff and employees or medical providers, as warranted.

My child is allergic to the following medications:

My child has had allergic reactions to the following (foods, dyes, latex, etc.)

My child has had an episode or been diagnosed with

My child is currently under doctor’s care for the following physical limitation or health conditions:

My child’s immunizations are current and up to date

Medical Information and Consent

By signing the Medical Information and Consent Box:
1. I warrant all the information provided is true and correct to the best of my knowledge; and
2. I agree:
a. to assume all responsibility for the health of my child.
b. and understand it is my responsibility to update the Medical Information & Consent Form if there are any changes to my child’s health.
c. and give permission to transport my child to a hospital/clinic for emergency medical or surgical treatment and that the child’s medical history information can be provided to the health care provider.
d. and understanding any costs associated with the medical treatment of the child will be the responsibility of the child’s parent or guardian.

I, the undersigned, agree to the terms above.

Parents information

Mother's Name

Phone Number

Phone Carrier

Occupation

Nationality

Place of Birth

Date of Birth

Father's Name

Phone Number

Phone Carrier

Occupation

Nationality

Place of Birth

Date of Birth

Parents live together?

Parents Divorced

Name of guardian if not parents

Phone Number

Relationship to child

Main language spoken at home

Second Language

Emergency Contacts

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. The emergency contacts may be asked to provide identification prior to releasing the student to same.

Name 1

Phone Number

Relationship to Student

Date of Birth

Name 2

Phone Number

Relationship to Student

Date of Birth

Name 3

Phone Number

Relationship to Student

Date of Birth

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, name, phone number, and date of birth 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 make a copy of it.

Agreements/ Terms

Registration Agreement

I understand and agree that I must keep registration and contact/pick-up information up-to-date by notifying office staff and teachers of any changes in writing. I understand and agree to my child being picked up by the emergency contact persons or persons for which MAS QURAN Institute has been notified in writing.

I, the undersigned, agree to the terms above.

TUITION PAYMENT/REGISTRATION AGREEMENT

By signing the Tuition Payment/Registration Agreement Box, I understand and agree to each of the following rules:
1. Payment for monthly tuition must be received within the first five calendar days of the month on days MQI has allotted for payment.
2. Registration fees are nonrefundable even if for any reason the child is unable to complete the year in the program.
3. Any parent who does not remit payment as per the set schedule will be called and sent a formal letter. If payment is not received immediately thereafter, the child will be removed from the program.
4. Registration fees and book fees are required prior to the beginning of the school year. Students cannot begin attending classes unless these fees are paid.
5. All parents are required to submit all required documents including medical paperwork during the registration period. Students will not be allowed to attend any program prior to submitting all the required paperwork. For students below the age of 18, medical documents must show that the students are up to date with all required immunizations.
6. All fees are non-transferable.

I, the undersigned, agree to the terms above.

PHOTOGRAPHY AND IMAGE RELEASE WAIVER

By checking the photography and Image Release Waiver box, I agree and give permission to MQI to:
A. Photograph or videotape my child in any school activities,
B. Use photographs, digital, and videos in school presentations, lessons or activities, or
C. Release or publicize for informational or news-related purposes about MQI or MAS Chicago.

I, the undersigned, agree to the terms above.

Acknowledgement

• I acknowledge that I have read and I agree to follow the registration rules and regulations.
• I acknowledge that I have received a copy of the tuition rules and regulations for the 2023-2024 school year. I also acknowledge that I read and agree to pay the tuition on time.
• I agree to pick up my child on time and to pay $10 for any time I pick up my child after the mentioned times stated in the terms above.

I, the undersigned, agree to the terms above.

Parent Information

Parent/ Guardian

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number

Please fill in the information below and we will contact you to get more details and answer questions in shaa Allah.

For more information 708-888-7072

Child information

Medical Condition Information

Parents information

Emergency Contacts

Agreements/ Terms

Parent Information

Location Information