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Registration Form

Father's Name

First

Last

Father's Email

Father's Telephone (WhatsApp)

Mother's Name

First

Last

Mother's Email

Mother's Telephone (WhatsApp)

Address

Number of Children

First Child Name

First

Last

First Child D.O.B

First Child Gender

Second Child Name

First

Last

Second Child D.O.B

Second Child Gender

Third Child Name

First

Last

Third Child D.O.B

Third Child Gender

Parental Consent & Acknowledgment

My children are at least 5 years of age
My children will listen to the Imam and teacher and will not misbehave during class hours
My children are capable of using the restroom facilities independently without assistance.

Child Father's Third

Emergency Contact Person Name

First

Last

Relationship

Telephone

Payment Options