Full Name of Child:(Required)
Full Name of Primary Guardian:(Required)

** The Signature of the parent is required on ALL forms and initials on some. ** Please read carefully then fill and sign accordingly.

Elementary & Middle School Admission
* Registration Form
* Physical Activity Statement
* Media Release
* Hifz Program Registration - Optional
* Child Care Sick Policy
* Authorization for Emergency Treatment Form
* Parent responsibility form
* Student Records Release Form
Student Birth Certificate
Florida Certification of Immun¬ization: Form DH-680
Religious Exemption Statement Form DH-681 Signed by The Florida Department of Education
School Health Entry Form: DH -3040
Registration Fee
Scholarship Award Letter - If Applicable

Student Information

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Student Living with:

school and Academic History

School Type:
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Has the student ever attended a full time islamic school before?
Has the student ever experienced any disciplinary issues, including suspension, at school?
Does this student have any special educational needs?

Parent / Guardian Information

Marital Status:
Primary Guardian Name:(Required)
Secondary Guardian Name:(Required)
Address (if different from student)
If the child is not living with both parents, the legal guardian must provide a proof of guardianship and fill out the section below:
and has/have legal authority and the corresponding duty in regard to his/her education. I certify that the information given in this application is complete and accurate and understand to make false statements within this application may result in the withdrawal and/or termination of admission. I agree to support and abide by the Salah Tawfik Elementary & Middle School regulations, policies, and guidelines for
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Sibling Information

Sibling 1 Name:
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Sibling 2 Name:
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Sibling 3 Name:
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Does your child take any prescribed medications regularly?
*If prescribed medication is necessary to be administered during school hour, please request a separate Authorization form complete and return the form to the office.


5 Please list at least two emergency contacts below in the event that the Parents and/or Guardians can’t be reached. These individuals will also have authorization to remove the student from the school and pick up the child during dismissal.
  • For all children's safety, it is critical for you or your authorized pick-up individuals to use your dismissal card to pick up your child. To ensure the safety of our school's staff and children, pl.ease keep your card in a secure location.
  • Please notify your authorized pick up individuals that they must bring government-issued identification when they pick up your child.
  • If your child(ren) is/are picked up after dismissal has ended, a late pick up fee of $10.00 for every 15 minutes will be added to your monthly invoice.
  • Salah Tawfik Elementary and Middle School reserves the right to contact and request the individuals above to pick up your child if he/she is not picked up by 3:40pm. In such cases, local authorities may be contacted.

  • Anyone not on this list MAY NOT pick up your child(ren) without prior approval from the parents or legal guardian. NO EXCEPTIONS. This is for the safety of all our students.
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    Dear Parent or Legal Guardian:
    Children will be participating in structured physical education activities of at least a moderate intensity level and for a duration sufficient to provide significant health benefits, subject to the differing capabilities of students.
    Is the child under treatment for any medical, surgical or mental disorder that may impact their ability to participate in physical activities?


    During the school year, photographs, audio and/or video recordings of our school, students and teachers may be taken for the purpose of promoting the school. These photographs and/or recordings may be used in the various mediums of advertising such as newspapers, brochures, social media, websites and other publications.
    Do you grant permission for your child to be photographed and/or recorded for the purpose explained above?
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  • I affirm that, to the best of my knowledge, all statements made herein are true and complete. I understand thatany admissions into Salah Tawfik Elementary & Middle School is contingent upon accurately completing this application and submitting the required supporting documents, records and transcripts. Furthermore, aplacement test may be required for all new and returning students.
  • I understand that a non-refundable registration fee must accompany this application and admission is notguaranteed. Salah Tawfik Elementary & Middle School does not discriminate on the basis of color or race,color, religion, national or ethnic origin, or sectarian affiliation in the administration of its educational policies,admissions policies or decisions, scholarship programs and other administered programs.
  • I undersigned, parent or Guardian, release Salah Tawfik Elementary & Middle School, their respective agents,officers, employees and volunteers from any liability, including injuries or illness, which may result from mychild’s enrollment in the school and waive any claim related thereto.
  • I understand that this application for admission to Salah Tawfik Elementary and Middle School does not admit my child unconditionally, but the school reserves the right to accept or reject a student on the basis of previousschool records, testing, and personal interview.
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    **This program is optional for parents who are interested. If not, please ignore this page.
    Salah Tawfik Elementary and Middle school is proud to offer a full-time Hifz Program for students who would like to memorize the Quran with Tajweed. The curriculum integrates intensive Hifz instruction with core curriculum academics.
  • We accept both boys and girls from Grades 4-8
  • Students must have A’s or A & B letter grades in all subjects.
  • The student must be well versed in reciting the Quran and should have the ability to retain memorizedsections.
  • Students should have the capacity to memorize at least one page a day.
  • Admission is based on the teacher’s assessment of the student. The probationary period is 90 days.
  • Hifz students will be evaluated annually for their performance of Hifz and academics.

  • Becoming a Hafiz takes a lot of hard work and dedication from the student as well as the parents. We cannotplace an exact time frame on how long it will take to become a Hafiz. Some students take less than one year tomemorize the Quran, while some students take up to three years or more. Our goal is to offer the student asupportive environment that is conducive to memorizing the Quran so that they may never forget it.

    Please assign your initials to the following policies:

    I, the Hifz parent, understand the rules and requirements of the Hifz Program.
    I take full responsibility for paying the Hifz Fees as established by STEMS Fee Schedule.
    I understand that the Hifz program is an extension to the academics and state funded scholarships do not cover Hifz Program fees.
    I agree to accept feedback/ final decisions of the Hifz teacher and the STEMS admin if my child is not able to continue with the program within 90 days of the start of Hifz or anytime during the year.
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    Children in child care environments are exposed to germs carrying disease and illness. The spread of disease cannot be completely prevented but this Child Care Sick Policy will help us to reduce the spread of illness whenever possible for all the children in our care.
  • Teachers cannot provide care for a sick child when this places the health of other children at risk.Please keep your child at home if s(he) is sick. A child that is sick cannot participate in dailyactivities and routines and cannot be successful in group care.
  • Each morning, and periodically throughout the day, our teachers perform quick health assessments onall children. If your child is found to be ill upon arrival, you will be asked to take your child home.
  • If a child becomes ill while in our care, we will notify you so that you can make arrangements to pick upyour child as soon as possible.
  • If you are not reachable, we will contact one of your emergency contact persons to pick up yourchild. You must provide local emergency contacts with appropriate phone numbers (for example cellphones, not just the home or work phones).
  • If you are asked to take your child home due to sickness and you are not able to keep them at home tocare for them, you must have a plan for backup care.
  • Fever with signs or symptoms of illness: an oral temperature of or over 100.4˚ F or underthe armpit (axillary) temperature of or over 99.4˚ F.
  • Diarrhea.
  • Vomiting.

  • Note: In case of fever, diarrhea and/or vomiting, the child should not return to school until 24 hours have passed since the last sign of the symptom.
  • Sore throat or difficulty swallowing.
  • Headache or stiff neck.
  • Severe itching or rashes.
  • Mouth sores.
  • Significant tiredness, irritability, crying.
  • Difficulty breathing, chronic coughing or wheezing.
  • Unusual nasal discharge
  • Constant pain in the stomach.
  • Behavior that seems slow, confused or disoriented.
  • Any contagious condition including ringworm, bedbugs, head lice, pink eye or COVID-19