Hifdh & Homeschool Registration

Hifdh & Homeschool Registration
Parent Name*

First NameMiddle NameLast Name
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
E-mail*
Phone Number*
Grade Level*
Current School*
Level of Memorization*
Level of Islamic Studies*
Do you require homeschool support?*

YesNo
Have you attended an information session before?*

YesNo
Does your child have any special needs? If so, specify.*
Additional Information
Should be Empty: