Registration Form - Al-Arqam
Hifdh Academy
Parent Information
*
Primary Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Contact
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Doctor Contact
First Name
Last Name
Phone Number
Format: (000) 000-0000.
I / hereby grant permission to Islamic Center of Naperville, or its authorized agent(s) to seek medical help for my/our child/ward in case of emergency when for reason beyond their control the authorized person(s) stated above cannot be reached
*
Students Registered
*
Select number of Students Enrolled:
*
prev
next
( X )
Al-Arqam Hifdh Academy One Student
$350.00
$
350.00
for each
month
Al-Arqam Hifdh Academy Two Students
$700.00
$
700.00
for each
month
Al-Arqam Hifdh Academy Three Students
$1,050.00
$
1,050.00
for each
month
Al-Arqam Hifdh Academy Four Students
$1,400.00
$
1,400.00
for each
month
Al-Arqam Hifdh Academy Five Students
$1,750.00
$
1,750.00
for each
month
Credit Card
Submit
Should be Empty: