Student's Name (First & Last) *

Student's Date of Birth (MMDDYYYY) *

Student's Current Grade Level *

Student's Allergies

Street Address *

City *

Zip *

Home Phone

Cell Phone *

Primary Email *

Secondary Email

Emergency Contact *

Emergency Phone *

Parent's Name (Youth Only)

Can the student speak Farsi? * Can the student speak Farsi? *YesNoSome

Can the student understand Farsi? * Can the student understand Farsi? *YesNoSome

Can the student read Farsi? * Can the student read Farsi? *YesNoSome

Can the student write Farsi? * Can the student write Farsi? *YesNoSome

Please agree to all the following: * Please agree to all the following: * I will commit to attend all classes except for emergency or serious conflicts. As a parent, I will become involved in PTA and school affairs as expected. I will follow all the guidelines and respect the rules for Persian School. Teachers, Coordinators of ICSNC Persian School, Persian School location and Iranian Cultural Society of NC, Inc. (including its members and Boards of Directors) are not liable or responsible for any personal injuries that occur on the premises during classes. I hereby grant permission for the ICSNC Persian School to photograph or video record my child during school activities and events, and to use these images for educational, archival, or promotional purposes in print and digital media.