Student Application Saleema Academy New Student Application Parent / Legal Guardian - please complete one appliction for each new student & click the "Submit" below. Student Information Student First Name * Student Middle Name * Student Last Name * Date of birth * Gender * Male Female Student Address * Student Address Student Address Student Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Please describe any food or medical restrictions that you want the school to be aware of. If NONE please type N/A. * Parent / Guardian #1 Information Parent / Guardian #1 First Name * Parent / Guardian #1 Middle Name * Parent / Guardian #1 Last Name * Parent / Guardian #1 Phone * Parent / Guardian is Father Mother Other Parent / Guardian #2 Information Parent / Guardian # 2 First Name Parent / Guardian #2 Middle Name Parent / Guardian #2 Last Name Parent / Guardian #2 Phone Parent / Guardian #2 is Father Mother Other Policy Review & Acceptance Please read and click indicating understanding and acceptance. I understand that participation in Saleema Academy’s Weekend program includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. I/we understand that my child’s participation in Saleema Academy’s weekend program is voluntary and that my child and I/we are free to choose not to participate. I/we consent to my child’s participation in any of the approved school activities. I understand that Saleema Academy, their employees, officers, volunteers and agents will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities. I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Saleema Academy, their employees, officers and agents, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in Saleema Academy's programs. I/We give permission for our son/daughter to participate in all Saleema Academy activities, and do forever release Saleema Academy and its teachers, staff, volunteers and agents from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program event, meeting, or practice. I also understand that the Late Fee policy will apply. I/We also give permission to Saleema Academy to use my or my child’s photograph publically. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. In the event of an emergency, I hereby certify that I am the parent/lawful guardian of the student listed above and grant to Saleema Academy, its employees and agents full authority to take whatever action they may consider appropriate under the circumstances involved regarding the health and safety of my child and authorize them to obtain emergency medical or dental services for my child, if necessary, at my expense. By signing this Agreement, I/we acknowledge that we have read and understand this document and accept the risk and responsibility of participation in Saleema Academy weekend programs. Legal Guardian Full Name * Application Date * Signature * Clear Submit Δ join us - do good Seek the hereafter in that which God has bestowed upon you. join us New Students Mansfield Texas USA join us Careers Mansfield Texas USA DONATE using paypal Contact us your ideas info@saleemafoundation.com+1 (817) 405-9513