Registration - Rahmania Institue

Your Lord has neither forsaken you nor hated you.
and indeed the hare after is better for you than the present. and verify, your load will give you so that you shall be well-pleased

REGISTRATION FORM

SELECT PROGRAM OPTION

Student Name

Student Date of Birth

Quaran Nazra Completed

Competency in English:

Language at Home:

Does student have any medical conditions we should be aware of?

PARENT/ GUARDIAN INFORMATION:

First Name:

Last Name:

Address:

City:

Postal Code:

Email Id:

Work:

Ext:

Cell:

Home:

EMERGENCY CONTACT INFORMATION (OTHER THAN PARENT/GUARDIAN):

First Name:

Last Name:

Address:

City:

Postal Code:

Email Id:

Work:

Ext:

Cell:

Home:

Agreement:

I, and

1. Agree to abide by the Rules and Regulations of the respective Quran Programs and confirm that we have provided the correct registration information to the best of our knowledge and agree to pay the fee on time (5th of every month).

***Make all checks payable to Rahmania Institute ***

2. We also understand that Rahmania Institute, teachers, and the program managers will not be held responsible for any liabilities in case of any accident that may occur on the premises of the venue, during or before, and after the program hours.

3. Parents/Guardians are responsible for prompt drop offs and pick-ups. The program managers and teachers will not facilitate any supervision other than during the program hours.

4. Students are responsible for their own belongings. Teachers and program managers will not be responsible for lost items.

Parent/Guardian Name:

Student Name: