North Austin Muslim Community Center::Home

NAMCC Summer School-2008 Registration Form

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Student Information:
Click here to add a child.

Please note that parents need to provide lunch for their children as it will not be provided by the school.


Parents’/Guardian’s Information:
Name*:
Relationship*:
Home phone*:
Work phone:
Cell phone :

Complete Address*:

Emergency Contact:	(In case the school is unable to contact a parent or a guardian)
Name:
Relationship:
Home phone:
Work/Cell phone:

Authorized Pick-up and Drop-off persons:
1) Name:
Contact Number:
2) Name:
Contact Number:


Medical Information:
Doctor:
Clinic/Hospital:
Clinic/Doctor's Phone:
Allergies/Medical Problems:
Medication:

Volunteer Info:	If you would like to volunteer please check below when you are available
	Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays

Tuition Payment:	$150.00 (1st child), $125.00 (2nd child), $75.00 (3rd child), $350 max
Amount Due**: $
Payment Mode:	Check Cash Online
	Please make checks payable to NAMCC

In case of an emergency, when the school is unable to locate a parent or a guardian, I as a parent or guardian, authorize NAMCC school personnel to resort to medical treatment for my child and to make whatever arrangements that it deems necessary at the parent's cost.
By clicking submit below, I attest that I have read the Parent/Teacher/Student Handbook 2007, and agree to abide by it. I also understand that I will be asked to fill out and sign the Medical Authorization and Parent Acceptance forms. Please click here to download the School Student/Parent/Teacher Handbook.


* = Required fields
** = Read only fields