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Daisy - New Student Enrollment Form

Student's Name:

Student's Email:

Select Students's Gender:

Male:		Female:

Enter Student's Birthdate as (MM/DD/YYYY):

Student's Grade/class in public school:

No. of years Student attended any Islamic School:

Parent ' s Name:

Home Address:

Parents ' s Email:

Parent's Phone Number for Daisy messages:

Security

DAISY Student Registration