Student’s full name: ___________________________ Program enrolled in: Full-time After School
Please initial each statement below:
_______ (initial) I understand that I am required to submit the following documents upon enrollment:
● Filled and signed application form
● Filled and signed enrollment agreement
● Copy of original Birth Certificate
● Updated health form
● 1 passport size photograph
● Most recently completed grade transcript/report card/standardized test score
_______ (initial) I understand that I am required to submit a one-time registration & supplies fee due at
the time of enrollment.
_______ (initial) I understand there will be a $35 bounced check fee if my check bounces for any reason.
For a declined credit card there will be a $10.00 charge.
_______ (initial) I understand that I am obligated to pay the agreed fee of $650.00 per month, dated the
1st or 15th of each month for the full academic year. In the event that I do withdraw my child in the middle of
the school year, I will still be responsible for TWO extra months from the time of withdrawal.
_______ (initial) I understand that if I fail to pay the obligated amount, Hidayah will contact me with the
amount due. Failure to pay within a month period from the time of the call will result in the dismissal of my
child from Hidayah.
_______ (initial) I further understand that late pick up fees will be enforced as follows: $5 first 10 minutes
and $1 every minute thereafter till the child is picked up.
_______ (initial) I understand and agree that I must comply with and adhere to all Hidayah policies for
the coming academic year. In case of policy change, Hidayah will email me the policy change.
_______ (initial) I agree to give permission to Hidayah to seek emergency medical treatment for my child
in case I cannot be reached by phone.
_______ (initial) I agree Hidayah may use my child’s picture in its brochure or facebook advertising
materials without any monetary compensation.
_______ (initial) I understand that if I choose to participate in the text messaging service, I will be
responsible for all related charges from my carrier and will not hold Hidayah responsible for any charges
related to this service.
_______ (initial) I understand that Hidayah will release students to both parents unless a court
custody/visitation order is presented.
_______ (initial) I have read and understood all that is stated in this form.
Parent’s Signature: __________________________________ Date: ________________________________