2026/2027 Girls Weekend Hifdh

Emergency Contact Information
Primary Emergency | Contact Name

First NameLast Name
Primary Emergency | Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Emergency | What is your relationship with this person?
Secondary Emergency | Contact Name

First NameLast Name
Secondary Emergency | Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency | What is your relationship with this person?

Medical Information
Health Card Number
Allergies
Additional Medical Notes
Terms of Agreement
In the event of an emergency, if I cannot be reached, I authorize the calling of a doctor/Certified Emergency Personnel and the providing of necessary medical services in the event my child is injured or becomes ill. I understand that although the Darul Tarteel Weekend Hifdh will be staffed by mature and responsible adults who will do their best to ensure the well-being of my child/children, I shall not find the Darul Tarteel Weekend Hifdh, Abu Huraira, or their staff liable for any injury or loss of property.

Payment Information
Tuition is $110 per child per month. Only payment option is monthly bank withdrawals on the 1st of every month. There is a $29 NSF charge. All requests to stop automatic withdrawals must be given ONE (1) month prior. No Electronic Funds Transfer (EFT) cancellations last THREE (3) months of school year.
Name of Account Holder

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Account Number
Institution Number
Transit Number

Photography & Media Release
I hereby give Abu Huraira Center consent to use and reproduce my child(ren)'s name/image for promotional, educational, and fundraising purposes related to Abu Huraira Center.
I understand and agree to the above statement.
Parent Signature
Date Signed

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

General Information