Quranic 5 child Terms: 4 payments of $250 / Month First Name:* First Name Required Last Name:* Last Name Required Address Line 1:* Address Line 1 is Required Address Line 2: Address Line 2 is not valid City:* City is Required Country:* Country is Required -- Select Country -- Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe State/Province:* State/Province is Required Zip/Postal Code:* Zip/Postal Code is Required Quran Class options (5:30pm-8pm):* Quran Class options (5:30pm-8pm) is Required Mon - Fri (5:30pm-8pm)Sat - Sun (5:30pm - 8pm)7 Days (5:30pm-8pm) 1st Student First Name:* 1st Student First Name is Required 1st Student Last Name:* 1st Student Last Name is Required 1st Student Age (7 yrs and up):* 1st Student Age (7 yrs and up) is Required 1st Student Gender:* 1st Student Gender is Required MaleFemale 1st Student Allergies:* 1st Student Allergies is Required 2nd Student First Name:* 2nd Student First Name is Required 2nd Student Last Name:* 2nd Student Last Name is Required 2nd Student Age (7 yrs and up):* 2nd Student Age (7 yrs and up) is Required 2nd Student Gender:* 2nd Student Gender is Required MaleFemale 2nd Student Allergies: 2nd Student Allergies is not valid 3rd Student First Name:* 3rd Student First Name is Required 3rd Student Last Name:* 3rd Student Last Name is Required 3rd Student Age (7 yrs and up):* 3rd Student Age (7 yrs and up) is Required 3rd Student Gender:* 3rd Student Gender is Required MaleFemale 3rd Student Allergies: 3rd Student Allergies is not valid 4th Student First Name:* 4th Student First Name is Required 4th Student Last Name:* 4th Student Last Name is Required 4th Student Age (7 yrs and up):* 4th Student Age (7 yrs and up) is Required 4th Student Gender:* 4th Student Gender is Required FemaleMale 4th Student Allergies: 4th Student Allergies is not valid 5th Student First Name:* 5th Student First Name is Required 5th Student Last Name:* 5th Student Last Name is Required 5th Student Age (7 yrs and up):* 5th Student Age (7 yrs and up) is Required 5th Student Gender:* 5th Student Gender is Required FemaleMale 5th Student Allergies: 5th Student Allergies is not valid Father's First Name:* Father's First Name is Required Father's Last Name:* Father's Last Name is Required Father's Phone Number:* Father's Phone Number is Required Mother's First Name:* Mother's First Name is Required Mother's Last Name:* Mother's Last Name is Required Mother's Phone Number:* Mother's Phone Number is Required I certify that the information provided on this form is true and accurate:* I agree that my children who are registered in the IAS Evening Quran classes will follow the rules of the IAS and will respect the IAS Masjid and Center:* I also agree that my children will follow the instructions provided by the Quran teachers and treat them with respect* I understand that the IAS will not be responsible for my children before and after the scheduled Quran class hours:* I understand the IAS Evening Quran classes are $50/child per month and agree to pay the fees on the 1st day of every month. Non-payment of the fees will result in the student not being allowed to attend* Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Have a coupon? Coupon Code: Invalid Coupon Stripe Name on the card:* Name on the card is required. Credit Card:* Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it. No val Please fix the errors above
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