Cur rent Date (mm/dd/yy): Your Email: Student Information: Date of Birth (mm/dd/yy): Place: Gender:MaleFemale Canadian /Landed Immigrant?CanadianLanded Immigrant Immigration Authorization Expiry Date (mm/dd/yy): Name & grade of any brother/s or sister/s attending (or will attend) IQRA Islamic School: Name: Date of Birth (mm/dd/yy): Father's Contact information: Mother's Contact information: Emergency contact (Not the name of the Parent/Guardian): General Information (If Applicable): Medical Information: 70375
