Darul Tarteel Adult Evening Hifdh

Medical Information
Health Card Number*
Allergies
Additional Medical Notes
Terms of Agreement
In the event of an emergency, if I cannot be reached, I authorize the calling of a doctor/Certified Emergency Personnel and the providing of necessary medical services in the event of injury or illness. I understand that although the Darul Tarteel Weekend Hifdh will be staffed by mature and responsible adults who will do their best to ensure the well-being of it's students, I shall not find the Darul Tarteel Weekend Hifdh, Abu Huraira, or their staff liable for any injury or loss of property.*

I agreeI disagree

Payment Information
Tuition is $80 per month. Only payment option is monthly bank withdrawals on the 1st of every month. There is a $29 NSF charge. All requests to stop automatic withdrawals must be given ONE (1) month prior. No Electronic Funds Transfer (EFT) cancellations last THREE (3) months of school year.
Name of Account Holder*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Account Number*
Institution Number*
Transit Number*

Photography & Media Release
I hereby give Abu Huraira Center consent to use and reproduce my name/image for promotional, educational, and fundraising purposes related to Abu Huraira Center.
I understand and agree to the above statement.*

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Signature*

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Date Signed*

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Date
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Darul Tarteel