Applicant information
Parent full name *
Student full name *
Email *
Phone Number *
Student Gender *
Student Age *
Street address *
Apartment/Unit
City *
State *
Zip code *
Can the student read Quran ? *
If no, can he/she read Arabic letters or words?
Clear selection
How many Juzu' the student memorizes of Quran ? *
Does the student have a first language other than English ? *
If yes, what is the first language ?
Does the student have basic knowledge of Islam (prayer/wudu) ? *
Does the student have any allergies (food/medicine) ? *
If yes, explain
Does the student have any special or medical needs/conditions ? *
If yes, explain
If yes, what is the student's physician name?
If yes, can you provide an emergency contact (other than parent) and mention the relationship to the student
Program Overview
The Omar Masjid Murabbi program is a community based initiative providing students mentorship through the teaching of Islam. Mentors are trusted volunteers from our community. The program fee is $30 monthly for the 1st student and $20 for each additional family member. Mentor's children are exempt from the fee.
Are parents interested in volunteering to become mentors (murabbi) ? *
If yes, can he/she read Quran ?
Clear selection
Waiver
The Omar Murabbi Program, which is a part of Masjid Omar Ibn El-Khattab, or any of its officials, teachers, volunteers, and other representatives, shall not be held responsible for any incident or accident that may occur in the Masjid Omar premises during or before and after the school hours. Parents/guardians are responsible for prompt drop-offs and pickups. The school will not facilitate any supervision other than school hours. Students are responsible for their own belongings and the school will not be responsible for lost items.
I agree and consent. Signature *
Date *
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