Registration for BEAM Members/Students
BEAM Members/students are students enrolled in any online or in-person BEAM program
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Gender
*
Female
Male
Child's Grade Level
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name
*
First Name
Last Name
Mother's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Email
*
example@example.com
Father's Name
*
First Name
Last Name
Father's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Email
*
example@example.com
Does your child have any special needs?
*
Would you like to register for Quran or Arabic Classes?
*
Quran
Arabic
Select the payment that matches with your desired class length and frequency.
*
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( X )
One 30 mins class per week
$36.40
$
36.40
for each
month
Two 30 mins classes per week
$72.80
$
72.80
for each
month
Three 30 mins classes per week
$109.20
$
109.20
for each
month
Four 30 mins classes per week
$145.60
$
145.60
for each
month
One 60 mins class per week
$72.80
$
72.80
for each
month
Two 60 mins classes per week
$145.60
$
145.60
for each
month
Three 60 mins classes per week
$218.40
$
218.40
for each
month
Four 60 mins classes per week
$291.20
$
291.20
for each
month
Submit
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