Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Childs Name *

First Name

Last Name

Childs Gender *

Male

Female

Child's Date of Birth *

MM

DD

YYYY

Child's Level of Arabic Reading *

Beginner - Starting or hasn't started Qaidah Intermediate - Half way through completing Qaidah Advanced - Started Quran

Beginner

Intermediate

Advanced

Preferred Payment Option? *

Annual Payment (Including a discount)

Termly Payment (3 Instalments)