Madrasah Student Registration

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Child's Full Name *

Child's Age *

Address *

Parent 1/Guardian's Full Name *

Parent 1/Guardian's Phone Number
*

Parent 2/Guardian's Full Name *

Parent 2/Guardian's Phone Number
*

Additional Emergency Contact Name and Number *

Allergies *

Yes (Specify Below)

Specify Allergies (If answered "yes")

Are you financially able to the required monthly fee? *

Yes

Are you also registering your child's sibling? *

Yes

Name of Sibling (If answer if "yes") (Additionally siblings must also be registered separately)

Level of Quranic Arabic *

Beginner (No Arabic Reading Knowledge)

Some Arabic Reading

Qur'an

Questions or Concerns?

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