OldOnlineRe-enrollment

Re-enrollment Application

This online re-enrollment form is for current Madina Academy families. If you are enrolling children for the first time, please visit the enrollment page and download the necessary documents.
This form assumes there are no changes that need to be made to the Emergency contact, photo/email authorization, nor Release forms. If any changes need to be made to any of these forms, please fill out the appropriate forms on the enrollment page and mail them to the school.

Parent Information

Please fill in both parents' information.

* Indicates required field

Father Name *

Father's E-mail *

Father's Phone Number *

Would you like to receive text messages on this phone number? *

Mother Name *

Mother's E-mail *

Mother's Phone Number *

Would you like to receive text messages on this phone number? *

Home Address/Phone

Home Address *

City *

State *

Zipcode *

Home Phone *

Children Information

Please fill in the following information for each child. If additional field are needed, please add them to the comment section at the end.

1st Child's Name *

Returning Status *

Incoming Grade *

2nd Child's Name *

Returning Status *

Incoming Grade *

3rd Child's Name *

Returning Status *

Incoming Grade *

4th Child's Name *

Returning Status *

Incoming Grade *

Medical Information *

Additional Information/Comments *

Tuition Contract Agreement

I (we) will pay the tuition for all my (our) children using the following payment option.

Payment Option: *

I (we) have reviewed the Tuition Policies on the enrollment page and have been given an opportunity to seek explanation for anything that needed to be clarified. I (we) clearly understand and accept the Tuition Policy as outlined by the Board of Education (“Board”) of the Academy. We agree to pay according to the payment option selected above.

Digital Signature *

First

Last

**Please note that application submission is NOT COMPLETE until the re-enrollment fee is paid and all required forms are submitted.**

Submit Application

Re-enrollment Application​for Current Parents

Re-enrollment Application

​Parent Information

Home Address/Phone

Children Information

Tuition Contract Agreement

​Please note that application submission is NOT COMPLETE until the re-enrollment fee is paid and all required forms are submitted.

Re-enrollment Application
for Current Parents

Parent Information

**Please note that application submission is NOT COMPLETE until the re-enrollment fee is paid and all required forms are submitted.**