Registration

📌 PARENT REGISTRATION INFORMATION

Complete Parents information below

Father- First name *

Select options

Option AOption BOption C

Father- First name *

Father – Last name *

Father Cell Phone *

Father Work Phone

Father Email *

Father Occupation *

Mother First name *

Mother Last name *

Mother Cell Phone *

Mother Work Phone

Mother Email *

Mother Occupation

Emergency Contact name *

Emergency Phone number *

Home Street Address *

Apartment unit

City *

State *

Zipcode *

Enter Student #1 details below

Student1 – First Name *

Student1 – Last name *

Student1 – Date of Birth *

Student1 – Gender *

Select an OptionMaleFemaleSelect an Option

Student1 – Last year Grade attended *

Select an OptionKG1st2nd3rd4th5th7th8th9th10thSelect an Option

Student1 – Grade enroll *

Select an OptionKG1wt2nd3rd4th5th6th7th8th9th10thSelect an Option

Enter Student #2 details below

Student2 – First name

Student2 – Last name

Student2 – Date of Birth

Student2 – Gender

MaleFemaleMale

Student2 – Last year Grade attended

KG1st2nd3rd4th5th7th8th9th10thKG

Student2 – Grade enroll

KG1wt2nd3rd4th5th6th7th8th9th10thKG

Enter Student #3 details below

Student3 – First name

Student3 – Last name

Student3 – Date of Birth

Student3 – Gender

MaleFemaleMale

Student3 – Last year Grade attended

KG1st2nd3rd4th5th7th8th9th10thKG

Student3 – Grade enroll

KG1wt2nd3rd4th5th6th7th8th9th10thKG

Enter Student #4 details below

Student4 – First name

Student4 – Last name

Student4 – Date of Birth

Student4 – Gender

MaleFemaleMale

Student1 – Last year Grade attended

KG1st2nd3rd4th5th7th8th9th10thKG

Student 4 – Grade enroll

KG1wt2nd3rd4th5th6th7th8th9th10thKG

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📌 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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