Quran Program Registration Form

Quran Program Registration Form
Date of Registration:
Students' Parent Information:
Fathers' Name:

First NameLast Name
Occupation:
Fathers' Phone Number:
Please enter a valid phone number.
Fathers' Email:
example@example.com
Mothers' Name:

First NameLast Name
Occupation:
Mothers' Phone Number
Please enter a valid phone number.
Mothers' Email
example@example.com
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students' Information:

Please list their First and Last Names
1: Name

First NameLast Name
New:
Gender:
Date of Birth:

MonthDayYear
Date
Level:
2: Name

First NameLast Name
New:
Gender:
Date of Birth:

MonthDayYear
Date
Level:
3: Name

First NameLast Name
New:
Gender:
Date of Birth:

MonthDayYear
Date
Level:
4: Name

First NameLast Name
New:
Gender:
Date of Birth:

MonthDayYear
Date
Level:
5: Name

First NameLast Name
New:
Gender:
Date of Birth:

MonthDayYear
Date
Level:
Pleasde select the Days:

Saturday 2:30 PM to 5:30 PMMonday & Wednesday 6:00 PM to 8:00 PMTuesday & Thursday 6:00 PM to 8:00 PM
At our Quran Program, we have designed a comprehensive curriculum that includes (Arabic Reading and writing, QAEEDAH NOORANIA, Quran Reading) interactive sessions, engaging activities, and creative projects to make the learning experience enjoyable and meaningful for your children. We have highly qualified instructors who are passionate about teaching Islamic studies and will provide a nurturing and inclusive environment for your children to thrive.

We strongly encourage you to enroll your children in our Quran Program to ensure they benefit from the invaluable teachings and experiences Islamic studies offer. Together, let us make this summer a time of spiritual growth, personal development, and joyful learning for our children.

If you have any questions or require further information, please do not hesitate to contact us. We look forward to welcoming your children to our Quran Program.

Emergency Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship:
Health Information
Name of the Student Please:

First NameLast Name
Injuries/illness:
Medical Needs:
Allergies:
Medication and Frequency:
Special Instruction: Please READ and SIGN.
I, the undersigned, am the parent/legal guardian of the student (s) and requesting admittance to MC School. Furthermore, each student being enrolled is in good health, and does not suffer from any illness; disability, or condition that requires the taking of medication on a regular basis, and any such condition is disclosed to and accepted by the school administration.
I also understand that there is no reason that each student on this form cannot or should not participate in vigorous practice or play. I, the undersigned, hereby expressly agree to be responsible for any medical bills incurred in the treatment of any illness or accident of the said student. In the event of any such accident or injury.

I hereby give my full consent to allowing the MC School Administration and MC staff to procedure any medical treatment deemed necessary and advisable on behalf of my child. I understand that, as a condition of admittance of each student, the undersigned, on behalf of all parents and guardians, and behalf of the applicant(s), hereby release; the MC School and its Staff and Principal, all and every member of School and MC Staff, and The Instructors from all and any liability resulting from Injury or illness, mental or physical, suffered by the student during or related to the school year.

Drop off and pick up must be on time, any Daley pick-up will be subjected to additional charges.
I, the legal Parent/guardian of:have read and understand the above and acknowledge and accept full responsibility as described above.
Signature:

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