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Quran Class

Quran Class Registration

Student Information

Name(Required)

Prefix First Last

Date of Birth(Required)

Application for 6 years or over. If a child 5 years old must accompanied by a parent.

Address(Required)

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

Phone(Required)

Email(Required)

Siblings

Name

Prefix First Last

Name

Prefix First Last

Name

Prefix First Last

Name

Prefix First Last

Name

Prefix First Last

Parents Information

Mother's Name

Name(Required)

Prefix First Last

Address(Required)

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

Phone(Required)

Email(Required)

Father's Name

Father's Name(Required)

Prefix First Last

Address(Required)

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

Phone

Quran Class Monthly Fee Per Child

Price:

Please Standing Order to Following Bank. Account Title: Cadishead & Irlam Islamic Centre Sort Code: 23-05-80 Account Number: 45633667 Ref: Student name

Quran Class

Quran Class Registration

Student Information

Siblings

Parents Information

Mother's Name

Father's Name

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