5925 Darlene Dr
Rockford, IL 61109



5921 Darlene Dr
Rockford, IL 61109

  • Facebook Social Icon
  • Twitter Social Icon
  • YouTube Social  Icon

©2019 by Rockford Iqra School. 

Registration 2018-19

For best results, please use a desktop or laptop to complete this application.

Before you begin to fill out the registration form, below, please take a look at our Admission Requirements. Please be advised that filling out a registration form does not guarantee your child's admittance to Rockford Iqra School until all the necessary steps and paperwork have been completed. Transcripts and report cards from a former school may be uploaded at the end of the registration form below. Original copies of birth certificates and medical records must be brought into the office to be verified and photocopied. All new students will be required to take an entrance exam.

Student Information

Does Your Child Have Any Medical Conditions/Allergies We Should Know About?
Can your child receive over the counter medications available for students in case of general aches and pains?

Please type all that apply below: (Acetaminophen, Ibuprofen, Allergy Relief, Antacid etc.)

Parent/Guardian 1 Information

Parent/Guardian 1 Address

Parent/Guardian 2 Information


Emergency Contact Information

Please provide information for 2 people not living with the child

Emergency Contact 1

Emergency Contact 2

Student Pick Up Authorization

Individual 1

Individual 2

General Permissions

Publicity and Photo Release:

File Uploads

Upload the necessary documents below. Be advised that original copies will still need to be brought to the office for verification. Please note:

  • Physical Examinations are required for all new students as well as returning students entering grades KG, 6, or 9.

  • Eye exams are required for all students entering Kindergarten.

  • Dental Exams are required for students entering grades KG, 2, or 6. 

If you have any of these additional items they can be uploaded in the "other" field.

Max File Size 15MB
Birth Certificate
Max File Size 15MB
Immunization Record
Max File Size 15MB
Max File Size 15MB

Typing your name below will act as an electronic signature. By signing you agree to:

  • Authorize the request of your student's records from a previous school (if applicable)

  • Authorize the school to take whatever steps needed to protect the health of the student in case of an emergency requiring immediate medical attention, and the parent/guardian or emergency contact cannot be contacted.

  • Inform the school of any changes, failure to do so may delay the processing of this application.

  • Understand that your child may be excluded from school if immunizations are not on file.

  • Authorize your child to receive developmental screening if the school's staff deem it necessary. I also authorize my locality's screening agency to release a complete copy of the screening report to the school if requested.

  • Understand that your child's transcripts/report cards will not be released if all payments due aren't paid or school properties including rental books are not returned before May 25th or before my children are transferred out.

  • I understand my children may not be permitted to attend class if tuition or other fees are not paid on time.

  • Certify that all information provided in this application/documents is true and accurate.

I understand that falsification of information or submission of misleading information will be cause for revoking this application, and I am held legally responsible for all information within this application.