Al-Arqam Hifdh Academy 2026-27 Registration Form
Father's Name:
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
Primary Email:
*
example@example.com
Primary Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Name in case of emergency:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Doctor Contact Name:
*
First Name
Last Name
Doctor's Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
I / We hereby grant permission to Islamic Center of Naperville, or its authorized representatives to seek medical help for my/our child/ward in case of emergency when for reason beyond their control the authorized person(s) stated above cannot be reached:
*
Students Registration Details:
Student #1
Student's Full Name:
*
First Name
Last Name
Student's Age:
*
Student's Age must be between 3 and 17 years old
Student's Gender:
*
Male
Female
Student's Current Level:
*
Beginner
In Between
Completed/Daur Phase
Please share any information about your child that may help the Hifdh instructor support them:
Student #2:
Student's Full Name:
First Name
Last Name
Student's Age:
Student's Age must be between 3 and 17 years old
Student's Gender:
Male
Female
Student's Current Level:
Beginner
In Between
Completed/Daur Phase
Please share any information about your child that may help the Hifdh instructor support them:
Student #2 Payment Calculation:
Student #3:
Student's Full Name:
First Name
Last Name
Student's Age:
Student's Age must be between 3 and 17 years old
Student's Gender:
Male
Female
Student's Current Level:
Beginner
In Between
Completed/Daur Phase
Please share any information about your child that may help the Hifdh instructor support them:
Student #3 Payment Calculation:
Student #4:
Student's Full Name:
First Name
Last Name
Student's Age:
Student's Age must be between 3 and 17 years old
Student's Gender:
Male
Female
Student's Current Level:
Beginner
In Between
Completed/Daur Phase
Please share any information about your child that may help the Hifdh instructor support them:
Student #4 Payment Calculation:
Students Registered:
Payment Information:
Al-Arqam Hifdh Academy 2026-27 Subscription:
*
prev
next
( X )
Al-Arqam Hifdh Academy 2026-27 Subscription
USD
for each
month
Email
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Total Calculation for Payment:
Should be Empty: