Registration Form - Al-Risala Academy

AL-RISALA ACADEMY
15-1224 Dundas Street East, Mississauga ON L4Y 4A2 Ontario Ministry of Education BSID 665670
Tel: (905) 232-8436
E-mail: info@alrisalaacademy.com
Fax: (905) 232-8437 Web: www.alrisalaacademy.com
Application for Admission
Please ensure that all required information has been provided.
Please submit the following to the School Office:
Completed application form
Recent photo of the applicant
Copy of applicant’s passport or birth certificate
Copies of applicant’s three most recent report cards
Copy of most recent transcript (if applicable)
Copy of applicant’s record of immunization
Photograph
Once the completed application form has been received, you will be contacted to arrange an interview with you and
your child.
Once all admission procedures have been completed, you will be notified of the decision regarding your child.
APPLICANT INFORMATION:
(please check one of the boxes)
Elementary (JK-Grade8) High School (Grade 9-Grade 12)
Admission to Grade _____________
Last Name First Name Middle Name Other
Street Address City Province Postal Code
Phone Number Birth Date: M/D/Y Place of Birth Gender
( ) - / / Male: Female:
Citizenship(s) Languages ESL Landed Immigrant
Yes: No: Yes: No:
*If you are a landed immigrant, please enclose a copy of proof.
*Proof of age and Name, please enclose a copy of birth certificate or passport
Applicant lives with:
(Please check all that apply.)
Father
Stepfather
Guardian/Other:
How did you hear about us? ___________________________________
Mother
Stepmother
Both Parents
Parents Divorced/Separated
FOR OFFICE USE ONLY
Received / / Interview / / Decision: ______________________________________
M D Y M D Y

PARENT/GUARDIAN INFORMATION
Mother’s Name/Guardian Address (if different from student) Phone Numbers:
Home: ( ) -
Email Address: Cell: ( ) -
Daytime/Work: ( ) -
Father’s Name/Guardian Address (if different from student) Phone Numbers
Home: ( ) -
Email Address: Cell: ( ) -
Daytime/Work: ( ) -
LAST SCHOOL INFORMATION
School/Grade (last attended) _________________________________ Phone ( ) -
Street address City Province Postal Code
EMERGENCY CONTACT INFORMATION
Emergency Contact # 1 Name Relationship Daytime phone number
Emergency Contact # 2 Name Relationship Daytime phone number
HEALTH INFORMATION
Family Physician Name ____________________________ Telephone ( ) -
Health Card Number ____________________________ Health Coverage Plan OHIP Other
* Please enclose a copy of Health card and Immunization Record
Medical Conditions/Allergies _____________________________________________________________________
1. Is the applicant taking medication on a regular basis? Yes No
If yes, please state particulars
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

PRINCIPAL’S REPORT
15-1224 Dundas Street East, Mississauga, ON L4Y 4A2 Ontario Ministry of Education BSID 665670
Tel: (905) 232-8436
E-mail: info@alrisalaacademy.com
Fax: (905) 232-8437
Web : www.alrisalaacademy.com
Note: We would appreciate it if you kindly comment on the following items about this student. Please
fax it directly to AL-RISALA ACADEMY
STUDENT’S NAME: ______________________ _______________________
Last
First
SCHOOL: _________________________________________________
(Last attended by the student)
This student has requested admission to: AL-RISALA ACADEMY
I / we authorize the previous school(s) that I have attended to release the following
information to AL-RISALA ACADEMY
_______________________________________
Name and Signature of student (guardian/Parent)
ATTENDANCE: ________________________________________________________
WORK HABITS: ________________________________________________________
________________________________________________________
________________________________________________________
BEHAVIOUR / SPECIAL NEEDS: __________________________________________
________________________________________________________
________________________________________________________
No. of Suspensions (if any) ______ for (reason) _______________________________
Was the student expelled from your school? ____yes, ____No
COMMENTS:
________________________________________________________
________________________________________________________
________________________________________________________
Form completed by:
___________________________________________________
Date: _________________
Principal’s / Counselor’s Signature: ____________________

ENROLMENT CONTRACT
If accepted by the Principal and with (my/our) payment of the appropriate enrolment deposit, please enter (my/our) (child/ward) as a
student at AL-RISALA ACADEMY. This is subject to general statements, rules, regulations, conditions, and traditions contained in the
student’s Handbook of AL-RISALA ACADEMY. All of the above are acknowledged forming part of this contract together with the following
conditions and terms:
1. All applicants must have a personal interview and participate in our academic screening procedures, where required.
2. The school Principal determines grade and classroom placement based on the interview and the authentic documents.
3. **All students must re-register for each semester (Re-registration form is different from New Student Form, All forms will be provided
by the office). A student’s Academic and Behaviour will be reviewed. Al-Risala Academy reserves the right to extend or withdraw an
offer of admission. Note: Submitting a registration form does not guarantee a seat. The principal will make the final decision.**
4. When an applicant is accepted or has re-registered at AL-RISALA ACADEMY, a separate and non-refundable cheque of CAN $ 500
should be written to cover application fee, registration, textbook usage, and other printed materials for the full academic year along
with a $450 cheque for the last month’s tuition.
5. 9 post-dated cheques must be made out to cover the fees for the whole school year. All cheques must be dated on or before the 4 th
day of each month (September, May). Please check the attached table for tuition fee information.
6. All graduating students will be assessed a Graduation Fee that may vary from year to year.
7. If the parents decide to withdraw their child(ren) from school before the end of the school year, the last month’s deposit will be
forfeited.
8. If the student is asked to withdraw from the school by the administration, the last month’s deposit will be refunded.
9. Fees must be paid for the full month in which student(s) begin(s) school.
10. Students previously enrolled at the school must pay the application fee and arrears (if any) on subsequent return.
11. After an NSF cheque, subsequent payments will be required by cash or a certified cheque. The NSF charge will be $30. Failure to
maintain payments or rectify due amount will result in demission of students from the school.
12. AL-RISALA ACADEMY will not be held responsible for injury to students after they have been dismissed at the end of the school day.
13. AL-RISALA ACADEMY is not liable for any property damage or personal injury which may arise during the transportation of students to
and from school by his/her parents or a third party.
14. (I/We) hereby authorize AL-RISALA ACADEMY to contact schools and other sources to obtain information to support this application.
(I/We) will not seek access to confidential recommendation and evaluation materials before or after (my/our) (child’s/ward’s)
admission. The undersigned releases every person and institution from any and all liability resulting from or pertaining to the
furnishing of records, documents and other information provided to AL-RISALA ACADEMY for that purpose.
15. The use of (my/our) (child’s/ward’s) photograph and information in school publications is authorized without compensation or fee.
Parent’s Signature: ____________________________
16. A positive and constructive working relationship between AL-RISALA ACADEMY, the student, and a student’s parents/guardians is
essential to the fulfillment of AL-RISALA ACADEMY’S educational mission. Thus, AL-RISALA ACADEMY reserves the right not to extend
the privilege of re-enrolment to a student if AL-RISALA ACADEMY reasonably concludes that the actions of the student or the
parent(s)/guardian(s) make such a positive and constructive relationship impossible or otherwise seriously interfere with the school’s
accomplishment of its educational purpose. Any conduct which is in violation of the Code of Behaviour outlined in the AL-RISALA
ACADEMY Code of Conduct and which the AL-RISALA ACADEMY administration considers detrimental to the student or the other
students of AL-RISALA ACADEMY, may be deemed adequate cause for appropriate disciplinary action, including suspension, expulsion
or demission.
17. If in the opinion of a properly licensed and practicing physician, (my/our) (child/ward) needs medical or surgical services which
requires (my/our) authorization or consent before the same can be supplied by the undersigned, (I/we) hereby authorize, appoint
and empower AL-RISALA ACADEMY to act as (my/our) agent to furnish on (my/our) behalf such oral or written authorization as may
be required. (I/we) release AL-RISALA ACADEMY from any and all liability which might arise from giving such authorization; it being
(my/our) desire that (my/our) (child/ward) be furnished with such medical or surgical services as soon as reasonably possible after
the need arises.
18. If this Contract must be placed in the hands of a lawyer for enforcement and/or collection, the undersigned agree to pay all costs of
enforcement and/or collection which shall include, but not be limited to, reasonable lawyer’s fees and costs.
19. Academic Condition: Students must earn an overall average of 70% and no less than 65% in the main compulsory courses (Math and
English) to be able to continue studying at Al-Risala Academy. Otherwise the student will be placed on Academic Probation.
20. Attendance Condition: The maximum number of days allowed for students to be absent is 15 days per semester. If a student is
absent for more than 15 days, proof must be submitted – such as a doctor’s note, hospital note, court documentation, etc. If a
student is absent for more than 15 days without providing adequate documentation, the student risks losing credits for his/her
classes.
21. Student Record: If a student decides to continue his/her studies outside of the Province or Country or decides to continue studies in a
virtual, long distance, or home school to achieve the Ontario Secondary School Diploma (OSSD); a fee of $200.00 per semester will
apply to maintain and update the student’s academic record. The student’s final transcript and/or the OSSD may be withheld until
such fees are paid. Unless the student’s record is transferred to another school, in which case, he/she will not be charged and Al-
Risala Academy will not be liable for any further updates and/or responsibilities to the student’s record.
______________________________
Parent or legal guardian’s Name (please print)
____________________________
Parent or legal guardian’s signature
______________________________ ____________________________ _______________________
Name(s) of person(s) responsible for fee payment Signature Date

Al-Risala Academy
15-1224 Dundas Street East Mississauga, ON L4Y 4A2 Ontario Ministry of Education BSID 665670
Tel: (905) 232-8436, Fax: (905) 232-8437
Email: info@alrisalaacademy.com
Web: www.alrisalaacademy.com
_________ __ TUITION FEE SCHEDULE 2012-2013_____________
Al-Risala Academy is honoured to offer our students a high standard of education from Pre-K through to
graduation from High School and strive to achieve these goals all within our Islamic environment. We
recognize the importance of such a valuable investment and we work towards achieving this with our
utmost commitment. If you have any questions in respect to the tuition fees, please do not hesitate to ask
us.
ADMINISTRATION FEES
$ Per month/10 months
Tuition Fees
One Child
MONTESSORI PRE-K JK-SK ELEMENTARY HIGH SCHOOL
$500-$600** $450.00 $400.00 $350.00 $475.00
First Sibling ** $420.00 $370.00 $320.00 $445.00
Second Sibling* ** $390.00 $340.00 $290.00 $415.00
Application Fees
(non-refundable)
New Students Only
$100.00 $100.00 $100.00 $100.00** $100.00**
* For Siblings in mixed grade levels a discount of $30.00 for each sibling will be applied ($60.00 for
third sibling etc.)
** The tuition fee will depend on the amount of students who will register for the Montessori program.
*** Please note that all new and existing Grade 3, 6 and 9 students are also responsible to include $55.00
for EQAO fee.
Please note, we will be issuing a discount of one month in tuition fees if all fees are paid
in full prior to the end of June 2012, in addition there will also be a half month deducted
from the tuition fees if all fees are paid in two instalments prior to the end of June 2012.
Please note that the application fees will be waived entirely if the registration is complete
prior to the end of June 2012.
MONTESSORI/PRE-K/JK-SK ELEMENTARY HIGH SCHOOL
Text Book Usage Fee
School Supplies (yearly) n/a $125.00 $225.00
Printed Material, Workbooks (upon
commencement of academic year only),
Computer Lab and Locker Rental
$150.00** $100.00 $145.00
ID Card, Lockers, Agenda, etc… n/a $25.00 $30.00
SUB-TOTAL $150.00 $250.00 $400.00
Refundable Text Book Fee upon
graduation or upon conclusion of
registration*
n/a
$100.00 $100.00
TOTAL (Yearly) $150.00 $350.00 $500.00
* The refund will be issued according to the condition of the book(s) at completion of usage.
** This fee will include all stationary and school supplies.
***Any NSF cheque will carry a charge of $20.00. Any replaced NSF cheque after the 10 th day of the month
will carry a charge of $40.00.

Al-Risala Academy
15-1224 Dundas Street East Mississauga, ON L4Y4A2 Ontario Ministry of Education BSID 665670
Tel: (905) 232-8436,
Email: info@alrisalaacademy.com
Fax: (905) 232-8437
Web: www.alrisalaacademy.com
FINANCIAL AGREEMENT
Between Al-Risala Academyand the parents of the student(s)
Father’s Name: _____________________________ ____________________________ _____________________________
Last First Signature
Mother’s Name: _____________________________ _____________________________ _____________________________
Last First Signature
Home Address: ___________________________________________________________________________________________
Telephone: H. ( ) _________-_______________ Cell, Father ( ) _________-_______________
Cell, Mother ( ) _________-_______________
No.
Student’s Name
1
2
3
4
5
6
Grand total
Grade
Application
Fees
Books, Printed
Material, Deposit
Tuition Fees/
Month
Tuition
Fees/ Year
Saving/10
months
Total
SCHEDULE OF REQUIRED FEES ($ per month/10 months)
****Please refer to fee structure included with this admission package
Terms of Financial Agreement:
Application fees, Books, Printed Material, Deposit, and Tuition for June 2013 are due upon registration and are non-refundable.
Post dated cheques for the remainder of the academic year and must be dated between the 1 st and the 4 th of the month.
NSF cheques will be charged a penalty of $25.00.
All other financial arrangements must be approved by consent from Al-Risala Academy.
Additional Comments:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_______________________ _______________________ _______________________
Account Receivable Parent Signature Date

Al-Risala Academy
15-1224 Dundas Street East Mississauga, ON L4Y 4A2 Ontario Ministry of Education BSID 665670
Tel: (905) 232-8436, Fax: (905) 232-8437
Email: info@alrisalaacademy.com
Web: www.alrisalaacademy.com
DONATION SLIP
I would like to donate the following amount $________________________
Circle One: Monthly
Single
DONATING BY CHECK
Please make your check out to Al-Risala Academy Ltd.
IF DONATING BY CREDIT CARD:
Circle your type of Credit Card:
VISA MASTER CARD OTHER_____________________
Credit Card Number: __________________ Exp Date: ________________
Name on the Card: __________________________
PLEASE PROVIDE THE FOLLOWING INFORMATION IN FULL:
Circle Your Preferred Title: MS MRS MR Other____________________________
First Name: ________________ Last Name:_____________________
Mailing Address: _____________________________________________________
City________________________________ Province___________________________
Postal Code__________________________ Email__________________________
Daytime Phone________________
Evening Phone_____________________
JAZAKOOM ALLAHU KHAIRAN