Jaamʿe Masjid Bellmore Maktab Registration Form
Please complete this form entirely to ensure the best placement for your child.
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Email *
Student Information
Student's Full Name *
Student's Age: *
Student's Gender: *
Student's Date of Birth: *
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Allergy Information *
Is your child allergic to any medication or food? If yes, please specify.
Parent Information
Father's Full Name: *
Father's Contact Information (Cell Phone): *
Mother's Full Name: *
Mother's Contact Information (Cell Phone): *
Home Address: *
Emergency Contact Information
Who should be contacted in the event of an emergency?
Full Name of Emergency Contact: *
Relationship to Student: *
Phone Number: *
Student Placement Information
Has your child completed any Nāẓirah (Qurʾānic reading)? If yes, how much and where. *
Has your child studied any Islamic Studies? *
What are the best ways your child gets motivated about learning?
Is there any thing we should know about your child, to help us serve him/her in the best way possible?
Further Information
Have you read and understood the JMB Maktab Handbook containing the policies and rules? *
The handbook may be downloaded from the website.
Payment Option *

Please select how you would like to make the payment. (Forms should be printed from the website and filled out.)

Waiver *
Have you read, understood and agreed with this waiver?
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