Hifz Registration 2025

1
Primary Parent/Guardian* This field is required.Please enter the primary parent/guardian details.
First Name
Middle Name
Last Name
2
Email* This field is required.Primary email used for confirmations and school information
example@example.com
Confirm Email
3
Address* This field is required.
Street Address
Street Address Line 2
City
Province
Postal Code
Canada
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Student Name* This field is required.
First Name
Last Name
6
Student Birth Date* This field is required.
Month
Day
Year
7
Student's Age* This field is required.
8
Student's Gender* This field is required.
Male
Female
9
Healthcard Number* This field is required.In the event of an emergency, we may need this information.
10
Please list any allergies or medical conditions
Huge
Large
Normal
Small
Ok
Ok
11
What is the relationship of student with the parent/guardian filling this form?* This field is required.
12
Emergency Contacts* This field is required.
13
Consent* This field is required.Please read carefully. When you sign this form you waive and release all claims for injuries your child(ren) might sustain arising out of their use of the facilities and participation in the activities and programs at the program, and the Hamilton Mountain Mosque. Acknowledge risk of injury: As a participant in the activities or programs at The program and the Hamilton Mosque, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which my child(ren) may sustain as a result of participation or use of such facilities, activities or programs onsite or offsite. Such activities may include sports, educational outings, field trips, and hikes. Waive, Release & Indemnify: I hereby waive, release and discharge any and all claims I may have or may acquire against program and the Hamilton Mosque, The Muslim Association of Hamilton (MAH), its officers, agents, volunteers and employees as a result of my or my child(ren)'s participation in the activities and programs onsite or offsite of the program and the Hamilton Mountain Mosque; and I agree to indemnify and hold harmless program and the Hamilton Mosque, The Muslim Association of Hamilton (MAH) its officers, agents, volunteers and employees from any and all claims resulting from injuries, damages, and losses, including death, sustained while I or my child are in the program and the Hamilton Mountain Mosque or on its property, or offsite, using its facilities, except for willful and wanton misconduct by program and the Hamilton Mountain Mosque and its authorized personnel.
Yes, I consent to the above.
14
Responsibility for Property Loss & Damage* This field is required.I understand that The Hamilton Mountain Mosque (1545 Stone Church Rd. E, Hamilton, ON) is a place of learning and worship and its use must be done with care and responsibility. I assume responsibility for all losses or property damage due to my child(ren)’s (registered included within this form) acts of carelessness, vandalism, theft, or arson, and not by an accidental act. I am responsible to replace items, equipment, or supplies as a result. I am financially responsible to ensure that any losses or property damages will be covered. I understand all that is written below. Definitions: Careless act: An unthinking, neglectful, or reckless act that results in damage or loss. Malicious act (vandalism): An act that results in willful physical damage to or destruction of property Theft: Taking of property without the owner’s consent Arson: Malicious burning or setting of fires. Accident: An event that occurs by chance and not through the carelessness or malicious act of any person.
Yes, I agree to the above.
15
Payment Details* This field is required.
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Hifz Registration
$250.00CAD for each month
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