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sunday school admission application

Weekend School Application/Registration Form                               

 

For printable Sunday school registration from click here:      n_durham_weekend_school_registration_form.docx

 

Northern Durham Islamic Association

2609 W. Carver St

Durham, N.C. 27705

(919) 908-8804

 

 

Weekend School

Registration Form

Date: _____________

1st Students Full Name: __________________________________________________________________

Birthdate: ______ Age: _____ Gender: (M/F)   Knowledge of Arabic: _____________________________

2nd Students Full Name: _________________________________________________________________

Birthdate: ______ Age: _____ Gender: (M/F)   Knowledge of Arabic: _____________________________

3rd Students Full Name: _________________________________________________________________

Birthdate: ______ Age: _____ Gender: (M/F)   Knowledge of Arabic: _____________________________

 

Parent/Guardian name: _________________________________________________________________

 

Address: _____________________________________________________________________________

 

Email address: _________________________________________________________________________

 

Home Phone: _____________   Work Phone: _______________   Cell Phone: ______________________

 

Emergency Contact Information

Name of emergency contact: _____________________________________________________________

 

Relationship to child/children: ____________________________________________________________

 

Phone Number: _______________   Address: ________________________________________________

 

Physician name and phone number: _____________________________________________________________________________________

 

Health insurance information: ____________________________________________________________

 

Are there any special concerns or considerations about your child that you would like to make us aware of? __________________________________________________________________________________

 

Signature of parent/guardian: _______________________________________________   Date: _______

 

Annual registration fee $125 for one child, additional $100 for second child, and an additional $75 for a third child. Maximum charge of $300 per family.

 

Please make checks payable to North Durham masjid

-------------------------------------------------------------------------------------------------------------------------------

FOR OFFICE USE ONLY:

Payment Received in Cash [  ]   Check [  ]         Remaining Balance: ________________________

Full payment due by: _______________         Full payment received on: ____________________

 

Today's Prayer Timetable

Sunday 17 Dec 2017
BeginsJama'ah
Fajr6:056:15
Zuhr12:121:30
Asr2:463:30
Magrib5:04
Isha6:207:00
Juma1:00

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