Youth Qur’an Program Enrollment Form

Child's Name *

First

Last

Date of Birth *

Parent or Guardian Name *

First

Last

Email *

Parent or Guardian Phone Number/s *

Phone number that the child will use for the Program *

Please select from the drop-down Menu *

All monthly fees are due the first of each month! We strongly encourage you to set-up autopay with Zelle or PayPal to avoid disruption of teaching.

Skype information *

Are you enrolling in our Dual Program (for 9-12 grade students) for Bachelor in Islamic & Arabic Studies? *

The Dual Program is a guaranteed acceptance into our university to earn your Bachelor in Islamic & Arabic Studies degree while you are still in School. This gives you the opportunity to graduate with your Bachelor degree sooner so you can be influential leaders in your communities sooner.

Parental Consent *

We need Parental Consent before your child/children will be taught. Please kindly state your name and your relationship with the child and state your authorization and consent with your full name or signature.