Student Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Information *

First Name

Last Name

Phone

(###)

###

####

Select Your Enrollment Option

July 7-10 ($150)

July 14-17 ($150)

July 21-24 ($150)

July 28-31 ($150)

2 Weeks: July 7-17 ($250)

3 Weeks: July 7-24 ($400)

4 Weeks: July 7-31 ($500)

Hot Lunch Option

Chicken Burger & Fries Combo - $8.00 Monday and Thursday Pizza - $2.50 per slice per child Hot lunch orders must be placed in advance. Don't forget to pack a water bottle and snacks for the day!

Yes, I would like to purchase lunch daily (additional cost)

No, we will bring lunch from home

Optional Activities

I am interested in booking Horse Riding sessions (appointment only)

Islamic Program Add-ons

Qaaidah Noorania

Islamic Studies

Art Projects, Nature Play, and Soccer

Payment Method

Payment details will be shared after registration.

Zelle

CashApp

Check

Option 4

Cash

Agreement

I confirm the information provided is accurate.

I understand tuition is non-refundable after July 1, 2025.

I consent to basic photos/videos of my child for internal use. (optional)