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

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

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

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

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

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

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

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*

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