WIS Registration

Weekend Islamic School - Registration

Registration for WIS at HCIC

Part I - Parent information
Father's name*
First Last
Father's Cell phone*
Mother's name*
First Last
Mother's Cell phone*
Home mailing address*
Street Address Address Line 2 City State ZIP Code
Home Phone, if there is one
Primary Email address*
This email will be used to send any WIS announcements such as Mid-term & Final exam, Quran competition, school closures, etc...
Enter Email Confirm Email
Part II - Emergency Contact
Emergency Contact Name*
Please list someone to call in case of an emergency if we are unable to reach either parents.
First Last
Emergency Contact Phone
Please put the best phone number for us to call
Emergency contact relationship to child/children*
Declaration*
I hereby authorize the BIS-WIS to take my child/children to a licensed physician or medical center in the event of an emergency in which neither parents can be reached.
- Check here to accept
Part III - Student information
How many children are you registering?*
Student # 1*
First Last
Student # 1 Date of Birth*
Students must be 5 years old by Sep 1, 2024 to enroll.
MM slash DD slash YYYY
Student # 2*
First Last
Student # 2 Date of Birth*
Students must be 5 years old by Sep 1, 2024, to enroll.
MM slash DD slash YYYY
Student # 3*
First Last
Date of Birth*
Student must be 5 years old by Sep 1, 2024 to enroll.
MM slash DD slash YYYY
Student # 4*
First Last
Date of Birth*
Students must be 5 years old by Sep 1, 2024 to enroll.
MM slash DD slash YYYY
Student # 5*
First Last
Date of Birth*
Student must be 5 years old by Sep 1, 2024 to enroll.
MM slash DD slash YYYY
Part IV - Fees
1 child - $300.00 2 children - $500.00 3 children - $700.00 4 children - $900.00 5 children - $1100.00
Please consider paying security charges ($50 per child)*
- Yes, I would like to pay for security
- No, I do not want to pay
Security Charges (1 Child)
Price:
Security Charges (2 Children)
Price:
Security Charges (3 Children)
Price:
Security Charges (4 Children)
Price:
Security Charges (5 Children)
Price:
Total
$0.00
Part V - Payment
Credit Card
Configuration Required: To use the Stripe field, please configure your Stripe Settings.

WIS Registration

Weekend Islamic School - Registration

Part I - Parent information

Part II - Emergency Contact

Part III - Student information

Part IV - Fees

Part V - Payment