Student Admission / Interest Form

IPC Jame Masjid – Madrasa Programs 2026/2027

As-Salāmu ʿAlaykum wa Raḥmatullāhi wa Barakātuh,JazākAllāhu Khayran for your interest in enrolling your child in the IPC Jame Masjid Madrasa Programs for the 2026/2027 academic year.Please complete this form with accurate information. Submission of this form does not automatically guarantee admission. Program availability, class capacity, student age/grade, and assessment requirements may apply.No payment will be collected through this form. Payment information and registration/payment links will be provided once admissions and program placements have been finalized. CLASSES WILL BEGIN SEPTEMBER 8TH 2026
Parent/Guardian Full Name

First NameLast Name
Relationship to Student
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child 1 Full Name

First NameLast Name
Child 1 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child age
Child 1 Gender
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Program(s) Interested In
Additional Comments or Questions
If enrolling more than one child, please list each additional child’s full name, date of birth, gender, and any relevant notes.
Should be Empty:

IPC Jame Masjid – Madrasa Programs 2026/2027