Information Registration Form

Information Registration Form!

Parent Name *

First

Middle

Last

Student Name *

First

Middle

Last

Student Gender *

Student Age *

Grade Applying for *

Previous School *

Previous School Address *

Previously Completed Grade *

Arabic Language Level *

Number of Surahs Memorized (QURAN) *

Email *

Phone # *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Nearest Islamic Center *

Nearest Islamic School *

How did you hear about us? *

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