IQRA Academy — Summer Program 2017 Registration Form
Assalamu Alaikum Dear Brothers and Sisters,

IQRA Academy of the Islamic Association of Cary (Cary Masjid) is pleased to inform you about our upcoming Summer Program. Registration is now Open! Registration Deadline is June 30th, and Space is Limited!

We will hold our Summer Program for Boys and Girls from July 4th till August 24th, three days a week, Tuesday-Wednesday-Thursday, from 8:30 am — 12:00 pm (Lunch will be provided!). Many fun and educational activities for our children are planned for this summer, in addition to Quran, Arabic, and Islamic Studies Classes. Our children will have Fun and Education within an Islamic Environment.

We will accept students from Pre-K — 12th Grade. Students must be at least 4 years old by July. Only students who were born before July 1st, 2013 will be enrolled (birth certificate may be required for children who look below age requirement).

For online registration, please, fill out the required information below and click submit. Otherwise, we have hard copies of the registration form available in the Masjid, or you can even print out a PDF copy from this link:
Please, submit your child's enrollment form by dropping it in the "Donations" Box outside the Musalla (Prayer Hall).

Tuition is $100 per month for one child, $180 per month for two children, or $240 per month for three children.

You can pay by card at the kiosk in the masjid or you can pay us directly by cash or check. You have to put the cash/check in an envelope, and write on the envelope: Summer Program 2017, Parent's Full Name, and Student(s) Full Name. Please, drop the envelope in the "Donations Box" outside the Musalla (Prayer Hall).

If you have any questions or concerns, please do not hesitate to email us at

Or contact us at these phone numbers:

Principal Sheikh Abdullah Khadra: (919) 618-5478

For General Information (Text or WhatsApp): (919) 917-6071

We look forward to having your children this summer!

We ask Allah to grant you and your children success and happiness in this life and in the hereafter.

IQRA Academy — Islamic Association of Cary

Student Information
Student's First Name
Your answer
Student's Middle Name
Your answer
Date of Birth
Student's Last Name
Your answer
Current School Grade
Parent Information
We would like to add you to the Parents' WhatsApp Group to facilitate communication between parents and school. If you don't have WhatsApp installed on your phone, please download WhatsApp from this link:
Street Address
Your answer
Your answer
Zip Code
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Father's Full Name
Your answer
Father's Work Phone
Your answer
Father's Cell Phone
Your answer
Father's Email address
Your answer
Mother's Full Name
Your answer
Mother's Work Phone
Your answer
Mother's Cell Phone
Your answer
Mother's Email Address
Your answer
Family Home Phone
Your answer
Medical History
Physician's Name
Your answer
Physician's Phone Number
Your answer
Pertinent Medical History
Your answer
Additional Students
Student 2 Information
Last Name, First Name, Middle Name, Date of Birth, Allergies?
Your answer
Student 3 Information
Last Name, First Name, Middle Name, Date of birth, Allergies?
Your answer
Student 4 Information
Last Name, First Name, Middle Name, Date of Birth, Allergies?
Your answer
Student 5 Information
Last Name, First Name, Middle Name, Date of Birth, Allergies?
Your answer
Authorization of Consent to Treatment of a Minor
I/ We, the undersigned, parent(s) of STUDENTS ENTERED ABOVE, a minor, do hereby authorize the Islamic Association of Cary, IQRA Academy, as agent for the undersigned to consent to any medical examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or specific supervision of any physician and surgeon licensed under the provision of the Medical Practices Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

This authorization shall remain in effect for Summer Program's period which begins in July 4th of current year and ends in August 24th, unless revoked in writing and delivered to the Islamic Association of Cary, IQRA Academy.

We hereby give permission for my/our child(ren) to attend the Islamic Association of Cary, IQRA Academy. I give the teachers and school administration permission to take any necessary action in the event of an emergency. We have provided the pertinent medical history and allergies for all students in this form.

Enter Initials
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Liability Release
Also, I/ We, the undersigned, agree to save and hold harmless The Islamic Association of Cary, and their respective departments, organizations, boards, commissions, officers, agents, and employees from any liability whatsoever for any harm, personal injury, or property damage which my child or I may cause or suffer arising out of his/her participation in the Summer Program. This release is effective until revoked in writing and delivered to the Principal of the School at the Islamic Association of Cary.
By signing this enrollment contract, I ______ to give permission to the Islamic Association of Cary to take pictures and videos of my child(ren) during school activities for the magazines, flyers, and the school's website and social media.
Dress Code
All students 5th graders and up who attend IQRA Academy of the Islamic Association of Cary (Cary Masjid) should follow the Islamic dress code.

For Girls:

-Hijab (covering the head and the neck)
-Jilbab (not necessarily black), abaya, dresses, or skirts (all must be loose and ankle length unless they are worn over loose fitting pants).
-Pants must be full length and loose fitting.
-Shirts must be loose, long sleeve and must cover the hips at least.
-All parts of the clothes must not be transparent, and you should not be able to see through at all.

For Boys:

-Pants must be full length, relatively loose fitting.
-Shirts should be loose and covering the hips (not tucked into the pants).

Please notice that students will be asked to contact their parents for a change of clothing if they are not dressed appropriately.

Signature: PRINT FULL NAME to indicate that you have read, agreed to and signed this form.
Your answer
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