Ummah School for Quran and Sunnat Ar- rasool
Online Application Form (2017-2018)
The Ummah Masjid is pleased to announce the start of a new Quranic School supervised by Sheikh: Abdallah Yousri and will be suitable for males and females of all ages and levels (beginnings to granting Ijaza). Our aim is to allow for delivery of content using multiple formats (at our facility, at home and online). Fees: Onsite groups 30$/month, Onsite private and Online sessions 10$/hour, Offsite 15$/hour
Email: Abdallah.yousri@gmail.com Cell: (902)221-3012
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Last Name *
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First Name *
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Gender *
Name of Father
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Name of Mother
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Date of Birth *
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Nationality of Birth *
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Email *
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Mailing Address *
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Cell phone # *
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home phone #
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Emergency Contact *
(Name / Number/ Relationship)
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Type of Study *
The Memorized Parts of the Quraan *
(Tajweed) Skills *
ARABIC Skills : SPOKEN
ARABIC Skills : UNDERSTOOD
ARABIC Skills : READING
ARABIC Skills : WRITTEN
English Skills: SPOKEN
English Skills : UNDERSTOOD
English Skills : READING
English Skills: WRITTEN
Student's HEALTH CARD #
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Any Allergies ? *
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Health Care Issues ? *
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Any current Medication ? *
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Any special needs required ?
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(1)I understand that as an individual and/or parent/guardian of my child that I accept and agree to abide by the Quranic School rules and regulations and will help my child understand and abide by these rules. (2) I understand that the information I provided is correct and updated. *
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