Registration Form

Comments or questions are welcome.

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REGISTRATION FORM (check all that apply)

PROGRAMS

ALKITAB PROGRAM: Quran reading and recitation using the Qaeeda Nooraniyah system. Fri & Sun Age 5-12

WEEKEND SCHOOL: Islamic studies, Quran recitation/memorization, Sports, etc. Sundays 10:00am -2:00pm

KARATE: Self-defense training offered by licensed Muslim instructor

Student Information (Please fill out one form per family)

First Name*

Last Name*

Grade*

Gender:*

Male Female

Date Of Birth*

Partent/Guardian Contact Information

RelationShip:*

Father Mother Guardian

Full Name*

Address*

City*

Zip Code*

Phone #*

Email:*

Emergency Contact (In case we cannot reach you)

Contact Full Name*

Phone Number*

Relationship*

I certify under penalty of perjury under the laws of the State of Tennessee that this information is true and correct. I understand that Memphis Islamic Center is not responsible for any injuries or loss of property that the registrant/registrants may incur while at school.*

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