Mekteb Play to Learn Registration
A fun and engaging Mekteb program for children ages 3–5, where they learn through play, stories, creative activities, and age-appropriate Islamic lessons.
Child Information
Child First Name
*
Child Last Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age (eligible ages: 3–5 years)
*
Please Select
3
4
5
Health conditions, allergies, special needs, or other important information
*
Parent / Guardian Contact Information
Father's Full Name
*
First Name
Last Name
Mother's Full Name
*
First Name
Last Name
Mother's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Consent and Signature
Which child are you registering?
*
Please Select
First child — $103.30 registration fee
Second child — $103.30 registration fee
Third or additional child — No registration fee
My Products
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Mekteb Play and Learn
$103.30
$
103.30
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Parent / Guardian Signature
*
Submit
Submit
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