Online Student Registration Form

Student Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Student Cell Phone

(###)

###

####

Quran Memorized *

Mark the Juz/Para that is completed.

NONE

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Full Name of Contact #1 *

First Name

Last Name

Cell of Contact #1

(###)

###

####

Full Name of Contact #2

First Name

Last Name

Cell of Contact #2

(###)

###

####

Annual Registration Fee *

An annual, non-refundable, registration fee of $20 will be collected from all students. This fee covers administrative costs and expenses.

Returning Student ($20)

New Student ($20)

Monthly Class Tuition *

Fees will be collected through EMT on the 20th of each month.

Full-Time Hifz ($250)

Part-Time Hifz ($80)

Pre-Hifz ($50)

Hafiz ($60)

Classical Arabic ($50)

Sisters Quran ($60)

Monthly Transportation Fee *

Transportation is available for Full-Time, Part-Time, Pre-Hifz, and Hafiz classes.

YES ($30)

NO

Pre-Authorized Debit Agreement *

Complete and sign a Pre-Authorized Debit Agreement Form.

Provided a VOID cheque or Direct Deposit Form from bank.

WhatsApp *

All urgent notices and reminders will be sent via WhatsApp. Please confirm that you give permission to be added to the appropriate WhatsApp group.

YES

NO, I do not have access to WhatsApp

ClassDojo *

Daily student attendance and progress will be communicated via ClassDojo. Please confirm that you have installed ClassDojo on your mobile or desktop.

YES

NO, I do not have access to ClassDojo.