Full Time Hifz

MASJID NOOR LONG ISLAND

11032 Park Ave, Huntington, NY 11743

feedback@masjidnoorli.net

www.masjidnoorli.net

(631) 683-4185
Full Time Hifz Registration Form

Parents Information
Father Name*

First NameLast Name
Parent Mobile Number*
Please enter a valid phone number.
Parent Email
example@example.com
Mother Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Child 1 Information Here
Student Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear

Fees Payment

My Subscriptions

Full-Time Hifz

$300.00 for each month

Full-Time Hifz & Bayan Academy

$500.00 for each month

Email

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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