Tahfidh al Qur'an - Registration Form
Dear Applicant,

Please fill out the form below to pre-register for the Tahfiz al Qur'an Program.

This registration form is the first portion of a multi-step admissions process. Please ensure you enter a valid email address that you check often. All future correspondence will be through email.

Qur'an for All. In Every Hand; In Every Heart.
Applicant Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Street Address *
Street No. + Street Name + Apartment No.
Your answer
City *
Your answer
Province *
Your answer
Country *
Your answer
Postal Code *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Personal Information
Name of Parent/Guardian *
Your answer
Parent/Guardian Telephone *
Your answer
Parent/Guardian Email *
Your answer
Emergency Contact
Full Name *
First Name + Last Name
Your answer
Applicant's Relation to Contact *
Your answer
Emergency Contact Telephone *
Your answer
Applicant's Educational Information
Islamic Education *
Mention: What + Where + When
Your answer
Current School / University (If applicable) *
Mention: current Grade/Year + Main Subject
Your answer
Medical Details
Do you have any medical conditions that may impact your study at Al Huda Institute or that may require attention while you are on campus? If so, what are they? * *
Your answer
Additional Information
Strengths, Weaknesses, Interests, extra curricular activties *
Your answer
Volunteer / work in community services *
Mention: What + Where + When
Your answer
Why do you want to enroll in this particular program ? *
Your answer
How did you hear about Al Huda Institute (website, flyer, family, friend, neighbor, other) *
Your answer
Supplementary Services Request
Do you require Childcare ? *
If Yes, Number of children and age(s)?
Mention: age of each child
Your answer
Applicant Consent
By submitting the form, I confirm that the information in this form is true and correct to the best of my knowledge. *
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