Course Registration Form

email: info@rumihouse.org
contact number: 571 634 2003
address: 4900 Leesburg Pike, Suite 203 Alexandria, VA 22302

Important Notice Before Completing the Form

This form must be completed by the father, mother, or a legally authorized family member who is responsible for the information provided.
The person completing the form is responsible for the accuracy and validity of all submitted information and documents.
Sensitive information, including date of birth, proof of residence, medical records, and vaccination documents, must be correct and valid.
After final approval by the school administrator, the information will be entered into the official database, and any changes are only allowed with the administrator’s permission.

Select the course type(Required)

In Person

Online

1. Parent/Guardian Information

Full Name of Father/Mother or Legal Guardian(Required)

Legal parent or guardian of the student

First Name Last Name

Contact Number 1 (Emergency)(Required)

For urgent contact

Contact Number 2(Required)

Secondary contact number

Email 1(Required)

Primary email for school communication

Email 2(Required)

Secondary email for school communication

Residential Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Proof of Residence(Required)

At least one of the following must be provided:

Valid lease or property ownership document
Utility bill (electricity, water, or gas) dated within 60 days
Bank statement or rental/home insurance statement
Other documents approved by the school

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Student Basic Information

Name(Required)

Legal first name of the student Legal last name of the student

Date of Birth(Required)

Must match official ID document

Upload Proof of Identity(Required)

Birth Certificate or Passport. At least one required

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Gender

Male

Female

Academic Records

Current Grade/Class(Required)

Include school name and address

Previous School

For transferred students

Academic Records / Report Card / Transcript

Upload file if available

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Health and Vaccination

Vaccination Records(Required)

Parent/guardian responsible for providing accurate information

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Medical Examination Certificate(Required)

Parent/guardian responsible for providing accurate information

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Illnesses / Allergies

Emergency Medical Information

Additional Information

SSN

Required for legal registration if available

Interests and Activities

Elective / Course Selection

Final approval by the school

Parent/Guardian Consent and Confirmation

Consent Checkbox(Required)

Confirms all information is accurate and parent/guardian takes responsibility for submitted documents

Option to Edit Before Final Approval Parent/guardian can edit information before administrator approval

Form Completer Information

Full Name of Form Completer(Required)

Father, Mother, or Legal Guardian

Relationship to Student(Required)

Example: Mother, Father, Legal Guardian

Electronic Signature(Required)

Confirms accuracy of information and legal responsibility

Electronic Signature(Required)

Confirms accuracy of information and legal responsibility