Course Registration Form

First Student Name*

First NameLast Name

First Student Birth Date*

MonthDayYear

First Student Gender*

Second Student Name

First NameLast Name

Second Student Birth Date

MonthDayYear

Second Student Gender

Third Student Name

First NameLast Name

Third Student Birth Date

MonthDayYear

Third Student Gender

Single Parent check the box

First Parent Name*

First NameLast Name

First Parent Phone Number*

Please enter a valid phone number.

First Parent Email*

example@example.com

Second Parent Name*

First NameLast Name

Second Parent Phone Number*

Please enter a valid phone number.

Second Parent Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Choose A Courses ($100 Per Course)*

QuranArabic ReadingIslamic Studies

Additional Comments

Payment Information*

Registration Fees

$5.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Ustaz Academy Quran School Rules *

Classes

Classes meet twice a week every week. Each session is 60 minutes long depending prayer schedule, day of week, and time of the year.
During Ramadan, classes meet once a week.
Please refer to calendar for annual schedule.

Enrollment Information

An enrollment application must be completed online for every student.
All new students are required to take a short placement test to determine their Arabic reading proficiency.
Enrollment is for the entire semester and carries over to subsequent periods unless student is withdrawn.

Tuition

$5 application fee
The monthly tuition fee is $100 per student
Tuition is based on enrollment for the entire trimester. Once students have enrolled, tuition for the entire trimester will have to be paid even if the student is withdrawn in the middle of the trimester. Students enrolling once a trimester is already in session will be charged from their start date.
Ustaz Academy Online Quran School ONLY accepts automatic payments.
The Online Quran School does not offer any automatic discounts for multiple children.

Attendance

Students are expected to have punctual and regular attendance.
Please notify the teacher if your child will be missing a class.

Homework and Communications
Parents should check their children’s notebooks for homework and important communication after each class. Parents should sign the homework if required.

Please Check the Box Below*

Ustaz Academy Online Quran School Acknowledgement Statement *I understand that my child(ren) will be committed and "locked in" for the entire trimester. The tuition charged and owed will be per trimester (1st: Jan-May, 2nd: June-July, 3rd: Aug-Dec) in which payment will be deducted monthly (unless I pay for the entire trimester up front), regardless of attendance. My child(ren) will be automatically enrolled in the next trimester unless I notify Ustaz Academy Online Quran School (info@ustazacademy.com) via email one month prior to the next trimester starting.

Student Registration Form