Al Medina Islamic School Registration
Registration form for Al Medina Islamic School 
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Email *
Assalamu Alaikum. Welcome to Al Medina Islamic School Registration. Please fill out the registration form in order to enroll.

Weekend classes will be held Sunday from 11:00am-1:00pm
Student Information
Session
 *
Required
First Name *
Last Name *
Date of Birth *
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Gender *
Classes 

1.   Memorization 
  • 30th Chapter with Tajweed rules. 
2. Islamic Studies
  • Islamic History, Fiqh, Aqeedah, Ethics and Morality
Parent / Guardian Information
First Name *
Last Name *
Address *
Phone Number *
Alternate Phone
Parent Email Address *
Emergency Contact Information
Name *
Relationship to Student *
Phone Number *
Alternate Phone
Fees
Tuition Fees:
  • Weekend School (Sunday 11:00am – 1:00pm): $100/month/per student
Late payment fees: 
  • Payment should be received by the 5th of the month 
  • After the 5th, late fee: $5 (no exception) 
  • After the 15th, late fee: $15 (no exception) 
  • After the current month, late fee: $30 (no exception)
Late pickup fees:
  • Please look at the class end times and pick up the students on time. Parents/Guardians should appoint a designated pick up person and let the school board know. Late fees of $20 will incur for every 15 minutes of delay in picking up.
The school reserves the right to dismiss students for non-payment of tuition fees
Please type your full name here, if you agree to the above *
Release, Waivers, and Other Important Information
I, the undersigned, hereby release, absolve, indemnify, and hold harmless MEC, their leaders, and anyone appointed by MEC, from
all liability from any injury or damage sustained while participating in the Quran School Program. Also, I do not know of any reason
that my child would not be able to participate in any activities related to the Quran School.
Please type your full name here , if you agree to the above *
Please enter today's date *
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