Hifz Summer Camp Registration Form

MASJID FATIMA ALZAHRA

55 Lake Shore Rd , Ronkonkoma , NY 11779

info@masjidfatimaalzahra.org

www.masjidfatimaalzahra.org

(631)-648-0100
Registration Form

First Participant Information Here
Name

First NameLast Name
Date of Birth

MonthDayYear
School Grade
Email
example@example.com

Second Participants Information Here
Name

First NameLast Name
Date of Birth

MonthDayYear
School Grade
Email
example@example.com

Third Participants Information Here
Name

First NameLast Name
Date of Birth

MonthDayYear
School Grade
Email
example@example.com

Fourth Participants Information Here
Name

First NameLast Name
Date of Birth

MonthDayYear
School Grade
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Fees Payment
Student Registration Fees
prevnext( X )
Weekly Half day
$100.00 Select Student

Weekly Full day
$175.00 Select Student

Total

$0.00
Type a question*

Dear Parents /Guardians Please sign this waiver with the summer came application . Thank you

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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