Register for Summer Youth Program ’24

Review Quran Summer ’24 (Purchase)

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Step 4 of 4 – Payment

Overview

Summer Youth Program: Review Quran with Understanding

Duration: 2 months (July 1^st– August 31^st)

Location: NW Houston

Timing: 11-1 PM CST

BOYS: Mon/Tues
GIRLS: Wed/Thurs

Fee: $425.00

Payable by:

Parent/Guardian Information

PARENT First Name

PARENT Last Name

Parent Phone #

Parent Emergency #

GUARDIAN First Name

GUARDIAN Last Name

Guardian Phone #

Guardian Emergency #

E-mail (For class related correspondence. NOT SPAM)

How many students will be registering?

Student #1 information

Student’s First Name

Student’s Last Name

Birth Date

Student 1 Gender

Male

Female

ALLERGIES OR OTHER CONDITIONS? (medical/physical)

ANY MEDICATION CURRENTLY TAKEN: (Type of medication and time of administration):

Student #2 information

Student’s First Name

Student’s Last Name

Birth Date

Student 2 Gender

Male

Female

ALLERGIES OR OTHER CONDITIONS? (medical/physical)

ANY MEDICATION CURRENTLY TAKEN: (Type of medication and time of administration):

Parent/Guardian Agreement

I, (parent/guardian), understand and agree that the students listed above will participate in COI (Circle of ilm) Summer Quran Review program and will remain on the class premises during program hours. I understand that I am solely responsible for his/her transportation and bear responsibility for my children after the end of each class.

AGREE (Parent/Guardian)

Student(s) Agreement

I (we) promise to obey all the rules of the program and respect all teachers and staff. I (we) promise to be punctual and work hard for the duration of the program.

AGREE Student(s)

Comments (optional)

ENTER COUPON CODE FOR 5% OFF: summer

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