Student Information *

First Name

Last Name

Date Of Birth *

MM

DD

YYYY

Gender *

Male

Female

Is This A Returning Student? *

Yes

No

Parent/ Guardian Information *

First Name

Last Name

Contact Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which program(s) are you registering for?

Qur'an Memorization &Tajweed

Arabic

Full time Online School

Preferred Class Format

1 on 1

Group Class

Does the student have regular access to a computer/tablet with internet?

Yes

No

Does the student have regular access to a quiet space for learning?

Yes

No

Are you comfortable using Zoom or similar platforms?

Yes

No

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

Country

(###)

###

####

Do you give permission for your child’s image to be used in class screenshots for promotional or documentation purposes? *

Yes

No

Do you agree to abide by the school’s code of conduct and attendance policy? *

Yes

No