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MYACD Registration Form

Muslim Youth Association of Capital District Al-Arqam Campus
The MYACD Youth Seminary is a certified, two-year educational and developmental program designed to nurture the next generation of young Muslim men and women. Our mission is to strengthen Islamic knowledge, character, and community through both structured learning and meaningful companionship. The program consists of two levels:
1. Youth Seminary 1 (ages 12–18): A two-year foundational program covering nine essential subjects in Islamic studies and personal development. Classes will be held on Saturdays.
2. Youth Seminary 2 (ages 14–20+): An advanced certificate program for graduates of Seminary 1 or students with equivalent background, focusing on Arabic language and core Islamic sciences. Classes will be held on Sundays.
Alongside the academic curriculum, students will engage in weekly discussions and social/outdoor activities, including sports, arts, and community service, designed to build brotherhood, leadership, and moral strength.

Tuition is $200 per semester per student (each semester is 4 months - Fall, Spring, and Summer, totaling 5 semesters for the full program). Payment may be made in full or in two installments.

Please complete this form carefully to secure your child’s place in the program.
Student's Information
Student's Name*

First NameLast Name
Student's Date of Birth
Program Selection*
Student's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student's Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the student have any medical conditions, allergies or disabilities that we need to be aware of?
Parent's Information
Father's Name*

First NameLast Name
Father's Phone Number*
Format: (000) 000-0000.
Father's Email*
Mother's Name*

First NameLast Name
Mother's Phone*
Format: (000) 000-0000.
Mother's Email*
Configurable list*
Type a question
Payment Information

My Subscriptions

MYACD Bi-Monthly Tuition

Payments stop after 4 months

$100.00 for each two months

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parental Consent
I/We, as parent(s) of the student filling this form, agree to his/her participation in the Youth Program
Parent Signature*

Clear
Should be Empty:

MYACD Registration Form

Student's Information

Parent's Information

Payment Information

Parental Consent