Registration Form
Quran, Qaida Nooraniya, & Islamic Studies
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1- Student's Full Name (First and Last) (1st child) *
1st Child date of of birth *
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DD
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2-Student's Full Name (First and Last) (2nd child)
2nd Child date of of birth
MM
/
DD
/
YYYY
3-Student's Full Name (First and Last) (3rd child)
3rd Child date of of birth
MM
/
DD
/
YYYY
4-Student's Full Name (First and Last) (4th child)
4th Child date of of birth
MM
/
DD
/
YYYY
5-Student's Full Name (First and Last) (5th child)
5th Child date of of birth
MM
/
DD
/
YYYY
Father’s Full Name *
Father’s phone number *
Father's Email Address *
Mother’s Full Name *
Mother’s phone number *
Mother's Email Address *
Address *
Emergency Contact: Full Name *
Emergency Contact: Phone Number *
Parent's Signature (type full name) *
Will you need financial assistance? *
The payment is expected to be made on January 17th, the first day of school, and not before. A link will be sent to parents which payments can be made on.
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