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    Please enter all numbers without spaces or brackets

    Current date

    Session


    Student Information

    Last name

    First Name

    Full name in Arabic

    Date of birth

    Place of birth

    Gender

    Address

    Apt:

    City

    Province

    Postal code

    Medicare Number

    Expiry date

    Does the student have any medical conditions?

    YesNo

    If yes please explain

    Does the student take any medications?

    YesNo

    If yes please explain

    Does the student have allergies?

    YesNo

    If yes please Explain




    Do you speak Arabic at home?

    YesNo


    Mother's Contact Information

    First name

    Last name

    Home phone

    Cell phone

    Email Address

    Address if different from student

    Tax Receipts

    YesNo

    I will be able to volunteer sometime during the school year

    yesNo


    Father's Contact Information

    First name

    Last name

    Home phone

    Cell phone

    Email Address

    Address if different from student

    Tax Receipts

    YesNo

    I will be able to volunteer sometime during the school year

    yesNo


    Emergency Contact

    First name

    Last name

    Home phone

    Cell phone

    Relationship to student


    PHOTO AND VIDEO CONSENT FORM

    I hereby give my consent to Al-Huda-Verdun School to use and broadcast any photographs /video/audio of my minor child on the official Al-Huda-Verdun School website and on other official sites: YouTube Channel, Facebook, as well as for media purposes, including promotional presentations and advertising campaigns. In addition, I waive all claims to compensation or damages based on the use of his/her image/voice by the school. I also waive any right to inspect or approve the finished works.
    I agree that all such works and any reproductions shall remain the property of Al-Huda-Verdun School, unless otherwise noted.

    AgreeDisagree

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