Evening quran classes Registration Alhumdulillah! Our Evening Quran Class registration for boys and girls ages 7+ at HICC Masjid is now open! NAZRA QURAN AND ISLAMIC STUDIES There are two sessions to select from: Session A - 5:00 pm to 6:30 pm (Registration FULL)Session B - 6:45 pm to 8:15 pm We will require a void cheque or pre authorized bank form to be sent to us via info@miltonmasjid.com. Please write full name of your child in the email and subject line: Evening Quran Class If for any reason you have trouble completing this form please call or text at 905-467-5097 Jazak allahu khairunStudent InformationHow many children are you registering? *1 child ($65 / month)2 children ($125 / month)3 children ($185 / month)Select a session for your child(ren) *Session B - 6:45pm to 8:15pmStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *1st Child's name *1st Child date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231st Child OHIP # *1st Student OHIP expiry date *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419232nd Child's name *2nd Child date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419232nd Child OHIP # *2nd Student OHIP expiry date *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419233rd Child's name *3rd Child date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419233rd Child OHIP # *3rd Student OHIP expiry date *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923Parent InformationFather's name *Father's email *Father's phone number *Mother's name *Mothers email *Mother's phone number *Additional InformationFamily doctor's name *Family doctor's phone number *Does your child(ren) have any special learning needs or physical difficulties?Does your child(ren) have any medical or other conditions (i.e. allergy)?Emergency Contact Information (other than parents)Emergency contact name *Emergency contact phone *Emergency contact relationship to student(s) *Consent ** I hereby release Muslim Association of Milton and it's affiliates, its volunteers, and employees from all claims for damage arising from any activity, accident or injury which is caused by or arises from the participation of the applicant (s) names herein, during any program or in any facility where the program is held.Consent ** I grant Muslim Association of Milton and it's affiliates full rights to use the images of my "child" resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications.Consent ** I agree to submit a void cheque or pre authorized bank form to be sent to info@miltonmasjid.com. Please write full name of your child in the email and subject line: Evening Quran Class Please note the following prices: 1 child = $65/ month 2 children = $125/ month 3 children = $185/ monthSubmit
