Qur'an Nazeera Registration Form

Qur'an Nazeera Registration

Adults and Kids
Student Information
Student's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Levels
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information

Required only if student is a child
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
2026–2027 Classes: Tuition rates already include the applicable sibling discount
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Saturday 9:00 AM - 10:00 AM
Once a week on Saturdays. Call us at 412-901-9027 for monthly installment option.

$500.00 Quantity



Saturday 10:00 AM - 11:00 AM
Once a week on Saturdays. Call us at 412-901-9027 for monthly installment option.

$500.00 Quantity



Tuesday 5:30 PM - 6:30 PM
Once a week on Tuesdays. Call us at 412-901-9027 for monthly installment option.

$500.00 Quantity



Monday 5:30 PM - 6:30 PM
Once a week on Monday. Call us at 412-901-9027 for monthly installment option.

$500.00 Quantity



Monday & Tuesday 5:30 PM - 6:30 PM
Twice a week on Mondays and Tuesdays. Call us at 412-901-9027 for monthly installment option.

$800.00 Quantity



Monday, Tuesday and Friday 5:30 PM - 6:30 PM
Three times a week on Mondays, Tuesdays & Friday. Call us at 412-901-9027 for monthly installment option.

$1,000.00 Quantity



Registration Fee
$75 Registration fee is waived if registration completes before 8/15/2026

$75.00 Quantity



Total

$0.00
Additional Students Information
If you are registering more than one student, then write their names with age in the textbox below.
Payment
Make a Zelle Payment by scanning the QR Code below or via email to mic08831@gmail.com.

Registration is only finalized when the full tuition is received and a copy of the receipt is sent to micnooracademy@gmail.com

Write note in memo: MIC Noor Academy Registration - Student's Name
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Qur'an Nazeera Registration

Student Information

2026–2027 Classes: Tuition rates already include the applicable sibling discount