Al-Quran Kids Academy Registration

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

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 *

Student 2 Name *

First

Last

Student 2 Age (on Sept. 1, 2020) *

Program to Enroll Student 2 In *

Student 3 Name *

First

Last

Student 3 Age (on Sept. 1, 2020) *

Program to Enroll Student 3 In *

Student 4 Name *

First

Last

Student 4 Age (on Sept. 1, 2020) *

Program to Enroll Student 4 In *

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 *

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

Al-Qur'an Kids Online Academy2020/2021 Registration

Parent Information

Student Information

Al-Qur'an Kids Online Academy
2020/2021 Registration