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Al Faruq Quran Home School Academy
Full Time Home School Program September 2023 intake
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* Indicates required question
Which program do you wish to enroll your child in?
*
Quran Only
Academics & Quran/Islamic Studies
Child's Legal First Name
*
Your answer
Child's Preferred First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Gender
*
Female
Male
What grade is your child in ?
*
Choose
Grade 1
Grade 2
,Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Child’s Age
*
Your answer
Child’s Date of Birth
*
MM
/
DD
/
YYYY
Does your child have any allergies? Please Explain
*
Your answer
Parent / Legal Guardian Name(First, Last)
*
Your answer
Parent / Legal Guardian Relationship to Child
*
Mother
Father
Other:
Parent/Legal Guardian Email Address
*
Your answer
Parent/Legal Guardian Phone Number
*
Your answer
Home Address
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Relationship to Child
*
Your answer
Emergency Contact Phone Number:
*
Your answer
Emergency Contact Address
*
Your answer
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