MASJID NOOR LONG ISLAND
11032 Park Ave, Huntington, NY 11743
feedback@masjidnoorli.net
www.masjidnoorli.net
(631) 683-4185
MAKTAB PROGRAM
Date: September 4th (First Day of Classes) Time: 5PM - 7PM
Parents Information
Parents Name
First Name
Last Name
Parents Mobile Number
*
Please enter a valid phone number.
Parents Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child 1 Information Here
Name
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Girls (All Classes Full)
School Grade
Completed Last Maktab Class
Please Select
Sister Sana
Sister Asma
Sister Hafsa
Hafiz Safa
Hafiz Salman
Hafiz Huzaifa
New Student
Child 2 Information Here
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Girls (All Classes Full)
School Grade
Completed Last Maktab Class
Please Select
Sister Sana
Sister Asma
Sister Hafsa
Hafiz Safa
Hafiz Salman
Hafiz Huzaifa
New Student
Child 3 Information Here
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Girls (All Classes Full)
School Grade
Completed Last Maktab Class
Please Select
Sister Sana
Sister Asma
Sister Hafsa
Hafiz Safa
Hafiz Salman
Hafiz Huzaifa
New Student
Child 4 Information Here
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
N/A
School Grade
Completed Last Maktab Class
Please Select
Sister Sana
Sister Asma
Sister Hafsa
Hafiz Safa
Hafiz Salman
Hafiz Huzaifa
New Student
Fees Payment
My Products
*
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( X )
1st Children
$
75.00
for each
month
2nd Children
75+60=135
$
135.00
for each
month
3rd Children
75+60+60=195
$
195.00
for each
month
4th Children
75+60+60+60=255
$
255.00
for each
month
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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