Registration Form
Fill out the form carefully for registration
What Session are you enrolling your child(ren)?
Please Select
Morning Madrasah (9AM-1PM)
Afternoon Madrasah (2:30PM-5:30PM)
Parent Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Contact (Optional)
First Name
Last Name
Phone Number (Optional)
Please enter a valid phone number.
How many child(ren) will you register?
*
Student Information
Child 1 Information
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Child 1
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 1 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 1 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 1 Medical Conditions or Allergies
Child 2 Information
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Child 2 Full Name
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 2 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 2 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 2 Medical Conditions or Allergies
Child 3 Information
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Child 3 Full Name
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 3 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 3 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 3 Medical Conditions or Allergies
Child 4 Information
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Child 4 Full Name
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 4 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 4 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 4 Medical Conditions or Allergies
Child 5 Information
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Child 5 Full Name
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 5 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 5 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 5 Medical Conditions or Allergies
Child 6 Information
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Child 6 Full Name
*
First Name
Last Name
Birthdate
*
 -
Month
 -
Day
Year
Date
Gender
*
Male
Female
Child 6 Qur'an Reading Level
*
Beginner – Recognizes Arabic letters, but can’t yet read full words
Basic Reader – Can sound out and read simple words and short phrases
Fluent Reader – Reads full surahs fluently (with some pauses or errors)
Advanced (Tajwīd) – Reads accurately with proper Tajwīd rules
Child 6 Qur'an Memorization Level
*
None – Has not begun memorizing
Short Surahs – Memorized a few short surahs (e.g., Juz ’Amma)
1–5 Juz – Memorized up through the first 5 juz’
6–15 Juz – Memorized up through the first 15 juz’
16–30 Juz – Memorized more than half (16–30 juz’)
Child 6 Medical Conditions or Allergies
End of Form
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