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Weekday: 5:00pm-7:00pm
Weekend: 10:00am-12:00pm
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Student's Information
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Male
Female
Language Preference
*
English
Français
Both
Medicare Card Number
Medicare Card
Click or drag a file to this area to upload.
Allergies
Additional Information
Schedule
*
Weekday: 5:00pm-7:00pm
Weekend: 10:00am-12:00pm
Private Quran Classes
Private Arabic Classes
Group Arabic Classes
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
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Parents Information
Father's Name
Father's Phone Number
Father's Email
Mother's Name
Mother's Phone Number
Mother's Email
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