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EPMA Weekend Islamic School -Registration Form
Please complete the following information. Inshallah the 1st day and Orientation will be on October 2nd, 2022 at 11am
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Email
*
Your email
Please complete all required information
Parent/Guardian Information
Is this a new registration ?
*
Yes
No
Father's First Name
*
Your answer
Father's Last Name
*
Your answer
Mother's First Name
*
Your answer
Mother's Last Name
*
Your answer
Address
*
Your answer
Address (City, State, Zip)
*
Your answer
Student(s) Details
Student Information (Name, Age, Grade)
*
Your answer
Student 2 (Name, Age, Grade)
Your answer
Student 3 (Name, Age, Grade)
Your answer
Student 4 (Name, Age, Grade)
Your answer
Would you like to Volunteer?
*
Yes
No
Emergency Contact Information (Name, Relation to student & Phone Number)
*
Your answer
Families with Financial difficulties may apply for tuition assistance, subject to approval by School board. Please ask for the application form if needed.
Annual Tuition : 1st child($300) 2nd($500) 3rd ($650) and 4+ ($750)
Do you need Financial Assistance?
Yes
No
Clear selection
You will received the Rules and Etiquette upon submission of completed application form.
Online Payment Information
We are accepting secure online payments please use ACH to pay school fees:
https://us.mohid.co/pa/allentown/epma/masjid/online/donation/index/4
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