MAQ Academy Registration 2025/26
This form is for parents or guardians to enroll their school aged children (ages 5-16) into Masjid Al-Qur'an's 2025/2026 Sunday School program. Sundays from 10:30am - 1:30pm during the academic school year.
Check Box to Confirm
*
I affirm & accept these terms & the waiver of liability.
Parent/Guardian Information
Parent/Guardian 1
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 2
First Name
Last Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child Information
Child 1
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Does the child have any known allergies?
*
Yes
No
Specify Allergies
*
Is there anything you would like to tell us about this child?
Child 2
First Name
Last Name
Age
Gender
Male
Female
Does the child have any known allergies?
Yes
No
Specify Allergies
Is there anything you would like to tell us about this child?
Child 3
First Name
Last Name
Age
Gender
Male
Female
Does the child have any known allergies?
Yes
No
Specify Allergies
Is there anything you would like to tell us about this child?
Child 4
First Name
Last Name
Age
Gender
Male
Female
Does the child have any known allergies?
Yes
No
Specify Allergies
Is there anything you would like to tell us about this child?
Emergency Contact
Please list a contact other than the adult registering the child(ren).
Name
*
First Name
Last Name
Relationship To Children
*
Phone Number
*
Please enter a valid phone number.
Medical Provider Information
Primary Care Provider (Doctor or Clinic Name)
Phone Number
Please enter a valid phone number.
Medical Insurance Provider
Payment and Signature
Signature
*
Date
*
/
Month
/
Day
Year
Date
Continue
Continue
Should be Empty: