K-12 Hifz / Qaeda Program Enrollment

Assalaamu Alaikum,

Please complete this form for each student separately.

Student Info

First Name *

Last Name *

Gender *
MaleFemale

Date of Birth *

School Grade *

Student has memorized *
One or more JuzSeveral SurahsStarting afresh

If memorized, specify number of Juz or Surahs

The student knows Tajweed *
YesNo

Previous Classes

Part Time Hifz program is for 1.5 hrs, Qaeda program is for 1 hr. Both are 4 days a week.

Student has attended similar Part Time Hifz program before *
YesNo

[group previous_duration]
(If you answered 'Yes' above, please mention the duration below - in months)

[/group]

Parent Info

Father First Name *

Father Last Name *

Phone *

Email *

Keep me posted on the following
Progress on the Full-Time Hifz programCall for volunteers

Mother First Name *

Mother Last Name *

Phone *

Email *

Keep me posted on the following
Progress on the Full-Time Hifz programCall for volunteers

Comment

Please mention in the comment below if you’re enrolling only for the Summer classes.

Please provide any other input not covered by the questions above