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Registration for Summer- Hifz School Trial Program
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* Indicates required question
Student Name
*
Your answer
Student Date of Birth
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MM
/
DD
/
YYYY
Grade in School
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Choose
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Can the student recite Quran with tajweed
*
Yes
No
Explain student's current status on Quran recitation and memorization
*
Your answer
Student's special medical condition or need, if any
*
Your answer
Family doctor contact information
*
Your answer
Parent/Guardian Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Fee (Please select one)
*
I am able to pay monthly fee
I am able to pay portion of monthly fee
I am not able to pay monthly fee and eligible to recover fee from Zakat fund
I would like to support the school with my zakat contribution
*
Yes
No
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