QSI - Evening Quran School Registration Form
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Start Date:Tuesday, November 15, 2016
End Date:Thursday, May 25, 2017
Days:
Monday:5:00 PM to 8:00 PM
Tuesday:5:00 PM to 8:00 PM
Wednesday:5:00 PM to 8:00 PM
Thursday:5:00 PM to 8:00 PM
Place:
Other Info:4 days a week

One Hour Periods,

Monday to Thursday

1st period: 5:00 - 6:00
2nd period: 6:00 - 7;00
3rd period: 7:00 - 8:00

Fees: $75 per Month
   
Student Info:
First Name:*
Last Name:*
Middle Name:
Gender:*
Birth Date:*
Guardian Name:*
(if applicable)
Relationship to Student:*
Home Phone: *
Mobile:
Email:*
Address:*
City:*
Province:*
Country:
Postal Code:*
Emergency Contact:  
Name:
Phone Number:

Mahmood Khan 438-879-8441