NDIA Al-Ikhlas Academy -  Application Form
NDIA Al-Ikhlas Academy - Application Form 2022 - 2023

North Durham Masjid
2609 W Carver St. Durham, NC 27705

Contact us at 919-908-8804
northdurhammasjid@gmail.com


Please note: 
-Registration starts August 20th & ends on September 10th. 
-Registration is not complete until first payment is made. 
-Registration will be closed after September 10th.

*Registration is not complete until either first payment (In case of multiple children) or full payment (in case of one child) is made.

*Please complete one online form per family.

Sign in to Google to save your progress. Learn more
Number of Children you wish to enroll: *
Student 1: First & Last Name:
 *
Student 1:  Grade level:
 *
Student 1: Age:
 *
Student 1:  Birth Date:
 *
MM
/
DD
/
YYYY
Student 1:  Knowledge of Arabic:
 *
Student 1:  Knowledge of Qur'an:
 *

Student 1: Mailing Address:

 *
Student 2: First & Last Name
Student 2:  Grade level:
Student 2: Age:
Student 2: Birth Date: 
MM
/
DD
/
YYYY
Student 2: Knowledge of Arabic:
Student 2: Knowledge of Qur’an:
Student 2: Mailing Address:
Student 3: First & Last Name:
Student 3: Grade Level:
Student 3: Age:
Student 3: Birth Date:
MM
/
DD
/
YYYY
Student 3: Knowledge of Arabic:
Student 3: Knowledge of Qur’an:
Student 3: Mailing Address:

Language Spoken at Home:

 *
Parent/Guardian Full Name:
 *
Parent/Guardian Mailing Address:
 *
Parent/Guardian E-mail Address:
 *
Parent/Guardian Phone Number:
 *
Emergency Contact Full Name:
 *
Emergency Contact Phone Number:
 *
Emergency Contact E-mail Address:
Emergency Contact Mailing Address:
 *

Do any of the Students above have any Allergies or Medical information that we should keep in mind?

 *

“I consent to be added to associated Al-Ikhlas Academy’s Parent WhatsApp group/s”

*

“I consent to my child/ren appearing (indirectly) in photos which may appear on the North Durham Masjid/Al-Ikhlas Academy website/associated platforms”

 *
I understand payment is $175/First child, $150/Second Child, $125/Third child, and any other sibling is free. 

I also understand that the fee structure is either:

A one-time full payment (in the case of only one enrolled student), due before September 10th, 2022. 

Or

The first Payment of $150/month for multiple enrolled children is due September 10th, 2022. And the following $150 is due on the 10th of each month until full payment is complete.
 *
Required
"I understand that payment is made via check or cash to either my child's teacher or Dr. Othman, and that my child's registration is not complete until it is submitted"
 *
Please submit your full name which constitutes as your electronic signature below:
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms