Al-Quran Kids Academy Registration

SUMMER 2021 QURAN READING REGISTRATION FORM

Please complete all sections in this form, then scroll to the bottom to click Submit.

Parent Information

* Indicates required field

Parent/Guardian 1 Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Student Information

Student 1 Name *

First

Last

Student 1 Age *

Preferred time slot (sessions meet Tuesdays, Wednesdays and Thursdays throughout summer) *

Student 2 Name *

First

Last

Student 2 Age *

Preferred Time Slot *

Student 3 Name *

First

Last

Student 3 Age *

Preferred Time Slot *

Student 4 Name *

First

Last

Student 4 Age *

Preferred Time Slot *

IF YOU HAVE TO ENROLL MORE THAN 4 STUDENTS, PLEASE COMPLETE AND SUBMIT THIS FORM, AND THEN SUBMIT A NEW FORM FOR THE REMAINING STUDENTS

Additonal Information You Want to Provide (please let us know here about any specific schedule issues you may have) *

I understand that I am expected to stay at the masjid during instruction time and supervise any children I may bring along. I understand there will be no child supervision or recreation provided. I agree not to drop my child(ren) off unsupervised to the masjid. *

I understand the above statements and agree.

Please be aware that the school may take pictures of the students to use for advertising and informational purposes. If you do not want your child(ren)'s pictures to be taken, please contact the School Administration or the Imam.

Submit

SUMMER 2021 QURAN READING REGISTRATION FORM

Parent Information

Student Information

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