Parent

Children

Consents

Payment

Parent or Guardian Information

Name *

Phone Number *

Email *

Home Address

Address Line 1 *

Address Line 2

City

State *

ZIP Code

Emergency Contacts & Authorized Pickups

Is Emergency Contact Information Same as Parent? *

Yes

Authorized Pickup Person(s) — Full Name and Relationship to Child*

Authorized Pickup Policy List every person authorized to pick up your child besides yourself. Children will only be released to individuals listed here.

General Students Information

How many children are you registering? (Maximum 6) *

Were all children on this application born in 2019 or earlier? *

Yes

Important Age Requirement Note If any child will not be 7 years old by August 5, 2026, please contact the Darul Huda Masjid Admissions Committee before submitting this form to request a waiver code.

✉️ darulhudamasjid@gmail.com 📞 (706) 489-4065

Invalid Waiver Code Above Call the management to get the correct code.

Child 1 — Information

Child 1 — Name *

Child 1 — Date of Birth *

Child 1 - Date of Birth *

Child 1 — Gender *

Child 1 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 1 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 1 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Child 2 — Information

Child 2 — Date of Birth *

Child 2 - Date of Birth *

Child 2 — Gender *

Child 2 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 2 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 2 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Child 3 — Information

Child 3 — Date of Birth *

Child 3 - Date of Birth *

Child 3 — Gender *

Child 3 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 3 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 3 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Child 4 — Information

Child 4 — Date of Birth *

Child 4 - Date of Birth *

Child 4 — Gender *

Child 4 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 4 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 4 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Child 5 — Information

Child 5 — Date of Birth *

Child 5 - Date of Birth

Child 5 — Gender *

Child 5 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 5 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 5 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Child 6 — Information

Child 6 — Date of Birth *

Child 5 — Gender *

Child 6 — Allergies or Medical Conditions (write "None" if not applicable) *

Child 6 — Learning or Behavioral Accommodations (write "None" if not applicable) *

Child 6 — Photo/Media Consent

I consent to my child being photographed or recorded for the masjid's educational and promotional use.

Required Policy Consent

I Agree With The Terms And Conditions

Terms & Conditions

Fall 2026 After School Maktab Program — please review before registering

Please read carefully. This is a binding agreement between you and Darul Huda Masjid. By registering your child, you are required to read, fully understand, acknowledge, and agree to every one of the thirteen sections below — including the payment and refund policy, attendance rules, Islamic attire guidelines, behavior and discipline policy, and health/medical authorization. This is not optional and applies to every family. Tap each section below to expand and read it in full before continuing to the registration form.

1. Registration & Payment

The program is open to children 7 years of age and older as of August 5, 2026. A written waiver from the Admissions Committee is required for any exception.
A $25 one-time Materials & Admissions Fee is charged per child. This fee is refundable only if all issued materials are returned in good condition.
Tuition is billed under one of two plans you choose at registration: Monthly ($100/month for the first child, $50/month for each additional sibling) or Per Semester ($400 for the first child, $200 for each additional sibling).
Tuition is fully refundable within the first two weeks of the term. After two weeks, refunds are prorated based on classes remaining.
Payment is processed securely through our Stripe-powered checkout using a debit/credit card or bank transfer (ACH). We do not currently accept PayPal.
Registration is confirmed only after payment is successfully processed, and a registration number is issued by email.

2. Attendance & Punctuality

Students are expected to attend every scheduled class, Monday through Thursday, 5:30 PM–7:30 PM, following the Gwinnett County Public Schools academic calendar.
Parents must ensure timely drop-off and pick-up. Children must be picked up by 7:30 PM.
Absences must be communicated in advance. Excessive unexcused absences may result in dismissal from the program.
Students may not attend other after-school clubs, sports, or optional activities during these program hours. Repeated conflicts may result in dismissal.

3. Special Needs & Accommodations

Parents must disclose any special needs, learning accommodations, or medical conditions in the registration form.
We will make reasonable accommodations where possible, based on staff and classroom capacity.

4. Proper Islamic Attire

Boys: Loose-fitting clothing — long pants, a thobe, kurta-pajama, or similar attire approved by the Darul Huda Masjid Madrassa Administration.
Girls: Loose-fitting clothing covering everything except the face and hands, typically including a hijab and a long, flowing outer garment such as an abaya. Clothing must cover the aurah in accordance with Islamic teachings.

5. Excellent Behavior

Students are expected to show excellent behavior and respect toward teachers, fellow students, and staff.
All students must follow the rules and regulations set by the program.

6. Disruptive Behavior & Discipline

If a student's behavior significantly hinders the learning environment or compromises safety, the program may take disciplinary action.
Disciplinary steps may include verbal warnings, reflection sessions, and — in severe or repeated cases — expulsion from the program.
The program will make a reasonable effort to communicate any concerns or disciplinary measures with parents/guardians before escalating.

7. Classroom & Masjid Etiquette

Classes take place inside the masjid's prayer area. Students must maintain respectful behavior and follow all masjid rules.
No food or drinks are allowed inside the prayer area.
Parents are responsible for ensuring their children understand and follow these guidelines.

8. Health & Safety

While the program takes necessary precautions, accidents or unforeseen circumstances may occur.
Parents agree to release the program, its staff, and volunteers from liability in case of injury, illness, or loss of personal belongings during normal program activities, except where caused by gross negligence.

9. Emergency Medical Treatment

In a medical emergency, parents authorize program staff to seek necessary medical treatment for their child.
Parents are responsible for any expenses incurred from such treatment.

10. Photography & Media (Optional)

Photo and video consent is optional and separate from this agreement — you will see a dedicated checkbox for each child on the registration form.
If granted, the program may use photos or recordings of your child for educational or promotional purposes. We will never publish a child's name alongside their image without separate written permission.
Declining this consent has no effect on your child's enrollment.

11. Parental Communication

Parents agree to maintain open, respectful communication with the Maktab/Madrassa administration about their child's progress, concerns, or contact-information changes.
Regular updates may be sent by email, text message, or phone call.
Parents and emergency contacts are asked to keep the program's phone number reachable and to answer or return calls from administration promptly. After three consecutive missed contact attempts during a documented emergency or urgent matter, staff will follow the emergency contact list provided at registration. Continued unreachability across multiple emergencies may be reviewed by the Admissions Committee, which will contact the family directly before any decision about continued enrollment is made.

12. Privacy & Data Protection

Personal information collected at registration is kept confidential and used solely for program administration.
We do not sell personal data to third parties.
Payment details are processed securely by Stripe and are never stored on our own servers.
Records are retained for the duration of enrollment plus one additional year, then securely deleted upon request.

13. Governing Law & General Provisions

These Terms are governed by the laws of the State of Georgia.
Darul Huda Masjid reserves the right to update these Terms, class schedules, or instructors as needed; registered families will be notified of material changes by email.
If any part of these Terms is found unenforceable, the remaining provisions stay in full effect.
This document, together with the registration form, is the complete agreement between the parent/guardian and the program.

Required Acknowledgment. By checking the box below on the registration form, I confirm that I have carefully read, fully understood, and voluntarily acknowledge and agree to all thirteen sections above in their entirety — including the payment and refund policy, attendance rules, Islamic attire guidelines, behavior and discipline policy, health/medical treatment authorization, communication expectations, and privacy policy of the Darul Huda Masjid After School Maktab Program. I understand this is a serious, legally binding agreement, that it applies for the full duration of my child's enrollment, and that I am responsible for ensuring I understand every section before submitting this form.

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