EIC - Youth [12-18] Interest List
We are in the process of assessing the community's need for a Friday evening youth class at EIC. Based on the overall community interest, we may add a tuition-based Fall session and let you know the details in-shaa-Allah. If you are interested, then please submit the below form for each child. Thank you.
Child's Full Name *
Your answer
Age *
Your answer
Birthdate *
format: mm/dd/yyyy
Your answer
Gender *
Father's Full Name *
Your answer
Mother's Full Name *
Your answer
Preferred Mobile Number *
Please include area code
Your answer
Preferred Email Address *
Your answer
Alternate Mobile Number
Please include area code
Your answer
Alternate Email Address
Your answer
Questions/Comments
Your answer
Submit
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