Noor Al-Quran Program

Step 1 of 3

Noor Al-Quran Program Monthly Subscription(Required)

Every Tuesday & Thursday
6:00 pm – 8:00 pm
Subscription will be deducted monthly

Price:

CAPTCHA

Child's Information

Name(Required)

First Last

Date of Birth(Required)

Allergies/Medical Conditions(Required)

Parent/Guardian's Information

Name(Required)

First Last

Relationship to Child(Required)

Email(Required)

Phone(Required)

Emergency Contact

Name(Required)

First Last

Phone(Required)

Consents

Student pictures use(Required)

I authorize the use of pictures of the above-mentioned participant to be posted on advertising media published by Kitchener Masjid

Yes

Liability waiver(Required)

I am aware that participation in the The mentor program at Kitchener Masjid has some inherent risks and injury can occur. In consideration of my child being allowed to participate in the The mentor program, I, the parent/guardian assume the risk of all injury and agree not to sue caused by or resulting from participating in this program.

I agree to the Liability waiver.

Refund Policy(Required)

I acknowledge that this fee is non refundable and that there is no reduction in fees or credits issued when a registrant is absent or is unable to attend for any reason.

Yes

I acknowledge that: Parents and authorized adults are responsible to drop off their children and pick them up on time.(Required)

Yes

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

Credit Card(Required)

Card Details

Cardholder Name