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IQRA EDUCATIONAL CENTER
STUDENT REGISTRATION FORM
2026–2027
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📌 STUDENT INFORMATION
Student Full Name: ___________________________________________
Date of Birth: ____________________ Gender: ☐ Male ☐ Female
Grade (2026–27): __________________________________________________
Home Address: ____________________________________________________
____________________________________________________
📌 PARENT / GUARDIAN INFORMATION
Parent/Guardian Name: ___________________________________________
Phone Number: ____________________________________________________
Email Address: ____________________________________________________
Emergency Contact (Name & Phone):
📌 PROGRAM ENROLLMENT (Select One or More)
☐ Weekend School (Sat/Sun)
☐ Qur’an Reading Program
☐ Tajweed Program
☐ Islamic Studies Evening Program
☐ Early Childhood Islamic Program (Ages 4–6)
☐ Youth Leadership Program
📌 FEE STRUCTURE
Weekend School:
- Annual Tuition: $350
- Monthly Plan: $45/month
- Registration Fee: $25
- Books & Materials: $40
Qur’an & Tajweed:
- 1 Day/Week: $50/month
- 2 Days/Week: $90/month
- Private Lessons: $25/session
- Materials: $15
Islamic Studies Evening:
- Tuition: $40/month
- Books: $15
Early Childhood Program:
- Tuition: $35/month
- Materials: $10
Youth Leadership:
- Tuition: $50/month
Family Discounts:
- 2 Students: 10% off
- 3 Students: 15% off
- 4+ Students: 20% off
📌 PAYMENT METHOD
☐ Credit/Debit Card (not available yet)
☐ Bank Transfer (Zelle)
☐ Cash
☐ Check (Payable to IQRA Educational Center)
☐ Online Payment: IQRAedu.org/pay (not available yet)
📌 MEDICAL INFORMATION
Allergies: _______________________________________________________
Medical Conditions: ______________________________________________
Medications: _____________________________________________________
📌 PERMISSIONS
☐ I give permission for my child to participate in all IQRA activities.
☐ I allow IQRA to use classroom photos for educational purposes only.
☐ I agree to follow IQRA policies, attendance rules, and payment schedule.
📌 PARENT/GUARDIAN SIGNATURE
Signature: _______________________________________________________
Date: ___________________________
📌 OFFICE USE ONLY
Registration Received By: _______________________________________
Date: ___________________________
Amount Paid: ____________________ Payment Method: ______________
Notes: ___________________________________________________________
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