Student Information

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* First Name

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* Middle Name

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* Last Name

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* Date of Birth

Date

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* Gender

Parent/Guardian Information

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* Parent/Guardian's Name

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* Address

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* Phone (Primary)

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* Phone (Alternate)

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* Email

Emergency Contact

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* Emergency Contact Name

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* Emergency Contact Phone

Authorized pick-up and drop-off person(s) contact Information

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* Name (primary)

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* Contact Phone (primary)

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* Name (Alternate)

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* Contact Phone (Alternate)

Medical Information

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* Doctor Name

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* Phone

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* Clinic/Hospital Name

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* Phone

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* Allergies/Medical Problems:

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* Medication

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* In case of an emergency, when the school is unable to locate a parent or a guardian, I authorize DUA personnel to resort to medical treatment for my child and to make whatever arrangements that deems necessary at the parent's cost. *

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* Does the student require financial assistance?

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* If you answered yes for financial assistance, is the student Zakat-Eligible?

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* How many students are you enrolling in this program?

Other Siblings Enrolled in DUA
Every student should have their own application. Other Sibling Information is for Tuition Discount Recognition Purposes Only

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* Student 1 : Full Name

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* Student 2 : Full Name

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* Student 3 : Full Name

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* Student 4 : Full Name

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