MASJID NOOR LONG ISLAND
11032 Park Ave, Huntington, NY 11743
feedback@masjidnoorli.net
www.masjidnoorli.net
(631) 683-4185
SUNDAY SCHOOL
Parent Information
Parents Name
*
First Name
Last Name
Parents Email
*
example@example.com
Parents Phone Number
*
Please enter a valid phone number.
Address
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
Female
N/A
School Grade
Completed Last Saturday Class
*
Please Select
Book 1
Book 2
Book 3
Book 4
Book 5
Book 6
New Student
Child 2 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 Saturday Class
Please Select
Book 1
Book 2
Book 3
Book 4
Book 5
Book 6
New Student
Child 3 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 Saturday Class
Please Select
Book 1
Book 2
Book 3
Book 4
Book 5
Book 6
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 Saturday Class
Please Select
Book 1
Book 2
Book 3
Book 4
Book 5
Book 6
New Student
Fees Payment
20% discount for every additional child (Monthly Recurring Payments.)
*
prev
next
( X )
1st Participant
$
50.00
for each
month
2nd Participant
50+40=90
$
90.00
for each
month
3rd Participant
50+40+40=130
$
130.00
for each
month
4th Participant
50+40+40+40=170
$
170.00
for each
month
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: