Print this form on Letter paper, portrait - it takes two pages. Bring it to the office filled in, or register online instead.

Arizona Cultural Academy Islamic Sunday School

Family registration form

One form per family. Please write clearly. * = needed.

Rather register on your phone? Scan the code or go to www.acasundayschool.org/register

1About this registration

School year 2026–27 The children join this school year.

2Parents

Parent

First name*

Last name*

Cell phone*

Email a sign-in linkTo the email above, to set a password.

The other parent (optional)

First name*

Last name*

Cell phone*

Email a sign-in linkTo the email above, to set a password.

3Children

Child 1

First name*

Last name*

Date of birth*MonthDayYear

School grade in 2026–27*

Classes*ArabicQuranIslamic studies

Office use

Arabic class

Quran class

Islamic studies class

Does your child have any allergies?*NoYes

If yes: What is your child allergic to?

If yes: Does your child need emergency medication, such as an EpiPen?NoYes

If yes: Which medication?

If yes: Will you provide it?NoYes

Any medical condition or daily medication the teacher should know about?*NoYes

If yes: What should the teacher know?

Help us place your child

Arabic reading*Not yetKnows some lettersReads slowlyReads wellNot sure

Quran*Just startingLearning Juz AmmaHalfway through Juz AmmaAlmost finished Juz AmmaFinished Juz AmmaBeyond Juz AmmaNot sure

Child 2

First name*

Last name*

Date of birth*MonthDayYear

School grade in 2026–27*

Classes*ArabicQuranIslamic studies

Office use

Arabic class

Quran class

Islamic studies class

Does your child have any allergies?*NoYes

If yes: What is your child allergic to?

If yes: Does your child need emergency medication, such as an EpiPen?NoYes

If yes: Which medication?

If yes: Will you provide it?NoYes

Any medical condition or daily medication the teacher should know about?*NoYes

If yes: What should the teacher know?

Help us place your child

Arabic reading*Not yetKnows some lettersReads slowlyReads wellNot sure

Quran*Just startingLearning Juz AmmaHalfway through Juz AmmaAlmost finished Juz AmmaFinished Juz AmmaBeyond Juz AmmaNot sure

Child 3

First name*

Last name*

Date of birth*MonthDayYear

School grade in 2026–27*

Classes*ArabicQuranIslamic studies

Office use

Arabic class

Quran class

Islamic studies class

Does your child have any allergies?*NoYes

If yes: What is your child allergic to?

If yes: Does your child need emergency medication, such as an EpiPen?NoYes

If yes: Which medication?

If yes: Will you provide it?NoYes

Any medical condition or daily medication the teacher should know about?*NoYes

If yes: What should the teacher know?

Help us place your child

Arabic reading*Not yetKnows some lettersReads slowlyReads wellNot sure

Quran*Just startingLearning Juz AmmaHalfway through Juz AmmaAlmost finished Juz AmmaFinished Juz AmmaBeyond Juz AmmaNot sure

More than three children? Fill in the Children part of a second form.

4Emergency care and medication

In a medical emergency, if we can't reach you, staff may get medical care for your children - this may mean a trip to the nearest emergency room.
Staff may give your children medication you provide, labeled with the child's name and instructions.

I agreeRequired to register. You give this once for your whole family; it stays on file in later years.

5Who else can we call?

Someone other than a parent we can call if we can't reach you.

No one to list yet

Emergency contact 1

First name*

Last name*

Cell phone*

How are they related to your children?*

Can pick up18+, may be asked for ID

Emergency contact 2

First name*

Last name*

Cell phone*

How are they related to your children?*

Can pick up18+, may be asked for ID

For example: Grandparent, Aunt or uncle, Older brother or sister (18+), Cousin, Family friend, Neighbor, Babysitter or nanny.

6Pickup safety

Is there anyone who must NOT pick up your children, or a custody arrangement we should know about?NoYes

If yes: Who must not pick up the children?*

If yes: Which children?All childrenChild 1Child 2Child 3

A court order or another documentPlease give the office a copy.

If yes: Anything the office should know? (optional, only the office sees this)

7Photos & agreements

Liability Waiver

I am the parent or legal guardian of the student(s) listed in this packet. I give my consent for them to participate in classes, activities, and events hosted by Arizona Cultural Academy Islamic Sunday School (ACA).

I acknowledge and agree that Arizona Cultural Academy Islamic Sunday School, its employees, agents, and affiliates will not be held responsible for any injury, loss, or damage that may occur to my child(ren) or their property while participating in ACA activities, including but not limited to those that occur during school hours, at extracurricular events, or while on ACA premises.

I understand that by signing this waiver I am voluntarily waiving any right to seek legal action against Arizona Cultural Academy Islamic Sunday School in the event of any injury, loss, or damage sustained by my child(ren) while participating in ACA activities.

I further acknowledge that this waiver may be used for legal and/or financial purposes if needed, and that I have read and fully understand these terms and conditions.

Emergency Medical Authorization

In the event of a medical emergency, if I cannot be reached, I authorize the staff of Arizona Cultural Academy Islamic Sunday School to secure proper medical care for my child(ren). I understand that this may involve transportation to the nearest emergency medical facility.

Health Information & Medication Authorization

I confirm that the health and allergy information I have provided is accurate. I understand it is my responsibility to notify the school of any changes and to provide any necessary medication. All medication must be clearly labeled with my child's name and instructions.

I give permission for school staff to administer the medication I provide and to take appropriate action in case of an emergency.

Photo & Video Release

Arizona Cultural Academy Islamic Sunday School may take photographs and videos during class, lunch, recess, field trips, special events, and celebrations. The choices I selected for each child in this packet apply to two separate uses:

School use: sharing photos with families, staff education, and school records.

Promotion and publicity: the ACA website (www.acasundayschool.org), social media, and flyers. All photos and videos used for publicity will be available for review upon request, and I may ask that any photograph not be used for publicity. Where possible, my child will not be identified by name.

Authorized Pickup Policy

Only parents/guardians and the adults I marked as authorized for pickup in this packet may pick up my child(ren). For the safety of all students, an authorized pickup person must be at least 18 years old and may be asked to show identification before a child is released to them. If my child needs to leave before the end of the school day, the person picking them up must come into the office and sign my child out.

Photos of the children for use inside the school?NoYes

Photos in the school's promotion and publicity?NoYes

By signing, you agree to the agreements above for every child on this form.

Signed by (your name)*

Signature*

Date*

8Home address (optional)

ZIP code

City

State

Street address

Office use

Family ID

Order #

Date

Payment typeFull yearFall semesterSpring semester

Also boughtBooksGeneral booksDonation

Paid byCashCheck #____Money order #____ZelleCard

Payment plan

Amount paid $

Taken by

Entered by

Items bought (titles, prices)

Other notes

7810 S. 42nd Place, Phoenix, AZ 85042 · Sundays 9:55 AM – 2:30 PM · Questions? [email protected]