Islamic Education Weekend Class Essentials of Islam FormSTUDENT’S PERSONAL DETAILSFirst NameLast NameEmailDate of BirthGender Male FemaleAddressAddress CityStateCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweNames of any brother(s)/sister(s) already attending the schoolPRESENT KNOWLEDGEName(s) of Islamic School(s) attended in the past and dates of attendance:Name of School (Any City/Country)FromToName of School (Any City/Country)FromToQuran Reading Knowledge: Beginner (No Knowledge) Intermediate (Some Knowledge) Basic (Good Knowledge) Expert (Advanced Knowledge)Islam/Fiqh Knowledge: Beginner (No Knowledge) Intermediate (Some Knowledge) Basic (Good Knowledge) Expert (Advanced Knowledge)Prophet Muhammad (S.A.W): Beginner (No Knowledge) Intermediate (Some Knowledge) Basic (Good Knowledge) Expert (Advanced Knowledge)HEALTH CONCERNSPlease provide information if any health problem requiring special attention:PARENT/GUARDIAN INFORMATIONFather NameFather’s EmailFather’s Office TelephoneFather’s Cell Phone TelephoneMother’s NameMother’s EmailMother’s Office TelephoneMother’s Cell Phone TelephoneDECLARATION I confirm that, to the best of my knowledge, the information provided in this form is correct. I have understood and agree to abide by all rules including discipline and tuition fee payment and refunds. I also acknowledge that while the NAIF does its best to ensure the safety of each participant’s life, health and property, NAIF cannot be held responsible for any damage to these.CONSENT FOR EMERGENCY MEDICAL TREATMENT I HEREBY GIVE CONSENT TO NAIF AND ITS AFFILIATES TO PROVIDE ALL EMERGENCY MEDICAL OR DENTAL CARE TREATMENT NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE APPLICANT NAMED ABOVE INCLUDING BUT NOT LIMITED TO CALLING 911.PHOTO RELEASE I, give permission to NAIF AND ITS AFFILIATES to publish photos/images/videos of me or my child on web site, and other social media and advertising material, including but not limited to: Facebook, Twitter, Instagram, Pinterest, YouTube, flyers, catalogs, brochures, and other advertising media. In granting this permission, I understand that NAIF may use them for purposes such as celebrating achievements and publicizing NAIF events. I am signing this release form with the knowledge that any photos/images/videos posted on the NAIF Web site and other social media and advertising material, as outlined above, can be downloaded and reprinted by various news organizations, including print, electronic and broadcast media, and I, therefore, release NAIF from any liability arising from use of my or my child’s photos/images/videos in postings. Additionally, I understand that there are potential dangers associated with the posting of personally identifiable information on a Web site. I further understand that if I wish to rescind this agreement, I may do so at any time by sending a request to NAIF in writing. The requested rescission will take effect upon NAIF’s receipt of the signed letter and will be applied for future incidents ONLY.Submit Form
