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
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 khairun

Student Information

How 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 A - 5:00 pm to 6:30 pmSession B - 6:45pm to 8:15pm

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

1st Child's name *

1st Child date of birth *

Month

Day

Year

1st Child OHIP # *

1st Student OHIP expiry date *

Month

Day

Year

2nd Child's name *

2nd Child date of birth *

Month

Day

Year

2nd Child OHIP # *

2nd Student OHIP expiry date *

Month

Day

Year

3rd Child's name *

3rd Child date of birth *

Month

Day

Year

3rd Child OHIP # *

3rd Student OHIP expiry date *

Month

Day

Year

Parent Information

Father's name *

Father's email *

Father's phone number *

Mother's name *

Mothers email *

Mother's phone number *

Additional Information

Family 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) *

Evening quran classes Registration

Student Information

Parent Information

Additional Information

Emergency Contact Information (other than parents)

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