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Home
Events
Spanish Sirah Event
Calendar
Al-Qur'an Kids Academy
Details
Registration
Madina Institute
Part-Time Islamic Studies Pgm
Syllabus
Madina Student Resources
Apply
Gallery
Watch
SummerCamp2019Pics
About Us
Prayers & Worship
About Us
Our Imam
Donate Now
Contact
Please complete all sections in this form, then scroll to the bottom to click Submit.
Parent Information
*
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Parent/Guardian 1 Name
*
First
Last
Parent/Guardian 2 Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Phone Number 2
*
Email
*
Student Information
Student 1 Name
*
First
Last
Student 1 Age (on Sept. 1, 2020)
*
Program to Enroll Student 1 In
*
Age 4-6: Story Time Sunday 10:30am - 11:00am, free of charge, times subject to change
Age 7-9: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 10-12: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 13 - 18: Sunday 10:00am - 11:30am, Tuesday and Thursdays 6:00 - 6:45pm
Student 2 Name
*
First
Last
Student 2 Age (on Sept. 1, 2020)
*
Program to Enroll Student 2 In
*
Age 4-6: Story Time Sunday 10:30am - 11:00am, free of charge, times subject to change
Age 7-9: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 10-12: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 13 - 18: Sunday 10:00am - 11:30am, Tuesday and Thursdays 6:00 - 6:45pm
Student 3 Name
*
First
Last
Student 3 Age (on Sept. 1, 2020)
*
Program to Enroll Student 3 In
*
Age 4-6: Story Time Sunday 10:30am - 11:00am, free of charge, times subject to change
Age 7-9: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 10-12: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 13 - 18: Sunday 10:00am - 11:30am, Tuesday and Thursdays 6:00 - 6:45pm
Student 4 Name
*
First
Last
[object Object]
Student 4 Age (on Sept. 1, 2020)
*
Program to Enroll Student 4 In
*
Age 4-6: Story Time Sunday 10:30am - 11:00am, free of charge, times subject to change
Age 7-9: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 10-12: Sunday 11:00am -12:30pm, Tuesday and Thursdays 6:00 - 6:45pm
Age 13 - 18: Sunday 10:00am - 11:30am, Tuesday and Thursdays 6:00 - 6:45pm
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
FEES:
$75 for 1 student
$150 for 2 students
$200 for 3 or more students
Little Kids Story Time for ages 4-6 is free!
Additonal Information You Want to Provide
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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.
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