InstructionsRead this carefully before proceeding.Bank InformationYou will need to provide bank account number and routing number with this form. Form will not be accepted without valid bank info. To get help on finding routing number, please see https://www.aba.com/about-us/routing-number We do not accept credit card or cash payments for Qur'an Class.Session TimingsOur timings are: Mon-Thu: Session 1 – 4:30 to 6:00 PM Session 2 – 6:00 to 7:30 PM Sat – Sun: Session 1 – 10:00 to 11:30 AM Session 2 – 11:30 to 1:00 PMAutomatic Monthly DeductionThe monthly deduction will be based on fee schedule displayed in https://masjidomartempe.org/quranschool/ If you need financial assistance, please contact the administration in person at the time of classes. Student #1 informationStudent First Name *Student first nameLast Name *Student last nameStudent Age (years) *Gender *MaleFemaleStudent Date of Birth *Select month123456789101112Select day12345678910111213141516171819202122232425262728293031Select Year20202019201820172016201520142013201220112010200920082007200620052004200320022001Choose your schedule *Please select an optionReading Weekends (2 days)Reading Week-days (4 days)Reading all week (6 days)Hifz (all week, 6 days)Session *1st2ndAdd another student? *YesNo, Go to parent infoStudent #2 informationStudent First Name *Student first nameLast Name *Student last nameStudent Age (years) *Gender *MaleFemaleStudent Date of Birth *Select month123456789101112Select day12345678910111213141516171819202122232425262728293031Select Year20202019201820172016201520142013201220112010200920082007200620052004200320022001Choose your schedule *Please select an optionReading Weekends (2 days)Reading Week-days (4 days)Reading all week (6 days)Hifz (all week, 6 days)Session *1st2ndAdd another student? *YesNo, Go to parent infoStudent #3 informationStudent First Name *Student first nameLast Name *Student last nameStudent Age (years) *Gender *MaleFemaleStudent Date of Birth *Select month123456789101112Select day12345678910111213141516171819202122232425262728293031Select Year20202019201820172016201520142013201220112010200920082007200620052004200320022001Choose your schedule *Please select an optionReading Weekends (2 days)Reading Week-days (4 days)Reading all week (6 days)Hifz (all week, 6 days)Session *1st2ndAdd another student?YesNo, Go to parent infoStudent #4 informationStudent First Name *Student first nameLast Name *Student last nameStudent Age (years) *Gender *MaleFemaleStudent Date of Birth *Select month123456789101112Select day12345678910111213141516171819202122232425262728293031Select Year20202019201820172016201520142013201220112010200920082007200620052004200320022001Choose your schedule *Please select an optionReading Weekends (2 days)Reading Week-days (4 days)Reading all week (6 days)Hifz (all week, 6 days)Session *1st2ndAdd another student? *YesNo, Go to parent infoStudent #5 informationStudent First Name *Student first nameLast Name *Student last nameStudent Age (years) *Gender *MaleFemaleStudent Date of Birth *Select month123456789101112Select day12345678910111213141516171819202122232425262728293031Select Year20202019201820172016201520142013201220112010200920082007200620052004200320022001Choose your schedule *Please select an optionReading Weekends (2 days)Reading Week-days (4 days)Reading all week (6 days)Hifz (all week, 6 days)Session *1st2ndAllergy informationParent/Guardian Name *Street Address *CityState/ProvinceZIP / Postal CodePhone *2nd Phone *Emergency Contact *We will use this contact if parents can not be reachedEmergency Phone *Parent Email Address *Email address confirm *Bank InformationHow to find routing number for your bank account?For help on how to find bank information, visit: routing number location .Bank Name *Bank Account Number *Routing Number *Upload a copy of the voided check from your bank accountChoose FileNo file chosenDelete uploaded fileThis will help us accurately setup your account. If you are unable to upload the image now, you must bring the voided check on the first day of the class.Release of Claims/ Covenants not to sueI consent *I/We give the Masjid Omar Ibn Al Khattab, Tempe, Arizona permission to call emergency medical services and render appropriate medical treatment to my child(ren) if needed.I consent *I/We understand that my monthly donation will be automatically deducted from my bank account on the 7th of each calendar month, and I will be subjected to $35 fee for any failed payments. Also I will need to give advance written notice to stop the payment when I withdraw my child(ren).I consent *In consideration for my being allowed to participate in any of Masjid Sponsored Programs (including but not limited to Qur'an studies, cooking, sewing, sports, volunteering, teaching and hosting any function), I/we thereby release, forever discharge and covenant not to sue Masjid Omar Ibn Al-Khattab, Tempe, Arizona and its trustees, officers, directors, employees, volunteers and assigns for any injuries, damages, liabilities, or other claims arising out of or connected with my/our participation in any kind of the program(s) or usage of related facilities.I consent *I/We hereby hold Masjid Omar Ibn Al-Khattab, Tempe, Arizona, its staff and volunteers harmless from any and all claims of liability and acknowledgement and accept the admission process and the guidelines. May Allah (s.w.t.) help me/us.Parent/Guardian Name *Today's date *Submit
