Weekend Madrasah Program

Student Name *

First Name

Last Name

DOB *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Cell Phone

(###)

###

####

Emergency *

(###)

###

####

Did your child attend weekend school in any other Islamic Center/Mosque?

Yes

No

Can your child read the Quran?

Yes

No

Can your child read Arabic?

Yes

No

Can your child write Arabic?

Yes

No

Agreement *

I the parent/guardian of the named student above agree to help and support Islamic Center of Southfield to encourage discipline and support the learning of my child. I will assure all the assignments and homework will be completed on a timely bases. In the event I have any concerns I will discuss with the teacher to resolve the matter.

I Agree