Madrassa Registration Form
Only Children 6 years and up will be accepted for Madrassah Classes at Markaz-ul-Islam.
Please fill all the information completely.
Email *
Student First Name: *
Student Last Name: *
Student Gender: *
Father's Name: *
Mother's Name: *
Date of Birth: *
MM
/
DD
/
YYYY
Address: *
City: *
Postal Code: *
Home Phone: *
Cell Phone:
Emergency Contact Name: *
Emergency Contact Phone: *
Emergency Contact Relationship: *
Student Alberta Health Care Number: *
Detail Message:
A copy of your responses will be emailed to the address you provided.
Submit
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