Membership Form
Parent First Name:
Parent Last Name:
Spouse Name:
Address:
City:
State:
Michigan
Postal Code:
Day Phone:
Evening Phone:
Email Address 1:
Email Address 2:
Emergency Contact Name:
Emergency Contact No:
Child
Age
Class Attending
Regular School
Sunday School
Select One
Pre-School
KG
1
2
3
4
5
6
7
8
9
10
11
12
Select One
Pre-School
1
2
3
4
5
6
7
8
9
10
11
Select One
Pre-School
KG
1
2
3
4
5
6
7
8
9
10
11
12
Select One
Pre-School
1
2
3
4
5
6
7
8
9
10
11
Select One
Pre-School
KG
1
2
3
4
5
6
7
8
9
10
11
12
Select One
Pre-School
1
2
3
4
5
6
7
8
9
10
11
Select One
Pre-School
KG
1
2
3
4
5
6
7
8
9
10
11
12
Select One
Pre-School
1
2
3
4
5
6
7
8
9
10
11
Select One
Pre-School
KG
1
2
3
4
5
6
7
8
9
10
11
12
Select One
Pre-School
1
2
3
4
5
6
7
8
9
10
11
Is this your first year at this school
?
Select One
No
Yes
If yes then did you attend any other Islamic school before
Select One
No
Yes
Name of the previous Islamic school you attend
Do you want to be a Volunteer
Select One
No
Yes
Please Select Area if you want to be a Volunteer
Select one
Operation Committee
Event Committee
Education Committee
Administration Committee
Publication Committee
Month your are able to help us
Start Month
Oct 02
Nov 02
Dec 02
Jan 03
Feb 03
March 03
April 03
May 03
June 03
End Month
Oct 02
Nov 02
Dec 02
Jan 03
Feb 03
March 03
April 03
May 03
June 03