Qur’an Class Registration Form

Please Note: You will need routing number and account number of your bank account (typically found on the check) to complete this form.

Without the bank information, the students' registration is not complete and they will not be able to join the classes.

For help on how to find bank information, visit: routing number location .

If you are registering your child for Hifz program, they will be tested on reading skills by the teacher before admitting them to the Hifz program. Student must be able to read from Mushaf independently with correct pronunciations (Makharij) and without any mistakes. Detailed Tajweed knowledge is not required.

STUDENT INFORMATION

Student 1

Student Name *

First

Last

Date Of Birth *//

Age

Sex *

Male
Female

Session *

Add Another

Add Another Student

Check this box if you want to add more students, otherwise just click on NEXT button.

Student 2

Student 2 Name *

First

Last

Student 2 Date Of Birth *//

Student 2 Age *

Student 2 Sex *

Male
Female

Student 2 Session *

Add Another 2

Add Another Student

Check this box if you want to add more students

Student 3

Student 3 Name *

First

Last

Student 3 Date Of Birth *//

Student 3 Age *

Student 3 Sex *

Male
Female

Student 3 Session *

Add Another 3

Add Another Student

Check this box if you want to add more students

Student 4

Student 4 Name *

First

Last

Student 4 Date Of Birth *//

Student 4 Age *

Student 4 Sex *

Male
Female

Student 4 Session *

Add Another 4

Add Another Student

Check this box if you want to add more students

Student 5

Student 5 Name *

First

Last

Student 5 Date Of Birth *//

Student 5 Age *

Student 5 Sex *

Male
Female

Student 5 Session *

FAMILY INFORMATION

Parent / Guardian Name *

Email *

Confirm Email

Primary cell phone number *

Alternate cell phone number

Street Address *

Address Line 1

City

State

Zip Code

How did you know about ICEV Qur’an Class?

Someone from family already registered
Friend
ICEV Newsletter
ICEV Website
Other

BANK INFORMATION

Bank Name *

Bank Routing Number (9 digits) *

For help on how to find bank information, visit: https://www.aba.com/about-us/routing-number

Bank Account Number (numbers only) *

Total Monthly Deduction Amount (for your ref only) *

Hifz is $80/month for first child. $75/month for each additional child.

Reading Weekdays is $50/month for first child. $45/month for each additional child.

Reading Weekends is $40/month for first child. $35/month for each additional child.

Calculate the total amount for your case and enter it here. This will be the monthly auto-deduction from your account. This amount is for your reference only. Administration will calculate the correct amount if you have entered wrong amount here.

We will stop auto-deduction when we receive the withdrawal form, when you leave the program in future.

ALLERGY INFORMATION

List the student name and allergy (if any)

If any of the students have food allergies, please list them here.

Disclaimers and Waivers

Dropoff and Pickup Policy *

I accept, acknowledge and confirm following statements:

Drop off and pickup policy: Parents must drop their students inside the Masjid. Students should be escorted to the class by the parents, and not dropped off in the parking lot. Parents must pick up students from inside the Masjid. Students will not be allowed to go outside without parent/Guardian permissions. If parent want to pick/drop their kids outside they need to sign waiver form that Teachers are not responsible when students are not in the Masjid.

Attending registered sessions only *

I accept, acknowledge and confirm following statements:

Students will come only the session they are registered. If a session change is needed, parents will fill out new enrollment form and submit to administration. All requests are subject to class vacancy.

Telegram App *

I accept, acknowledge and confirm following statements:

Parents agree to get Telegram App and register for Qur’an School text alerts. To get ICEV Qur'an School updates alert on cell phone via text message. Please download Telegram App. for Qur'an School message signup visit https://t.me/icevquranschool from your mobile phone.

Discipline *

I accept, acknowledge and confirm following statements:

Students are expected to behave Islamically and obey all instructions from teachers and administration. A quiet and peaceful learning environment is essential for our success. Any student who is in violation of disciplinary rules will be subjected to further actions including suspension and termination.

Tuition Aid and Renewal *

I accept, acknowledge and confirm following statements:

Parents can apply for tuition aid in case of financial hardship. Supporting documentation explaining the financial aid is required. All tuition aid will need to be renewed every year in January. Parents who are receiving the tuition aid (discount/ fee waiver), must contact the administration with financial need, to renew the aid. If renewal is not requested, the tuition will fall back to regular published amounts (as indicated on current admission form) from February.

How to contact admin or teachers *

I accept, acknowledge and confirm following statements:

Contact Administration: quranschooladmin@icevmasjid.org Phone Number 480-788-8051 Contact Teachers: Set the appointment by sending a message to administration email above. Do not talk to any teacher during the class time.

Miscellaneous information *

I accept, acknowledge and confirm following statements:

Withdraw student(s) and stop the automatic payment: Please fill out the withdrawal form and submit to administration from our website icev.org Any change of information: Fill out the enrollment form with new information and send it to administration. You can get the form on ICEV.ORG Your cell phone number and email address will be automatically enrolled in ICEV messaging system. Please check your email and text messages frequently for important updates from administration.

General Financial Waiver *

I accept, acknowledge and confirm following statements:

I, the parent/guardian of the child(ren) listed in form, who plan to participate in ICEV Qur’an program which require the child(ren) to stay at the facility hereby waive all claims against ICEV and its officers, directors, employees and volunteers in case of any accidents, incidences or medical emergency during the stay. We also agree that we will assume full financial responsibility and pay for any damages to ICEV facility, equipment, furniture etc. caused by our children.

Waiver of Liability for Communicable Diseases Including COVID-19 *

I accept, acknowledge and confirm following statements:

The novel coronavirus (“COVID-19”), has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. While rules, guidance, and personal discipline may reduce this risk, the risk of serious illness and death does exist. ICEV-Qur'an School cannot completely mitigate the transfer of communicable diseases like COVID-19 especially when involved in Qur'an School activity. Participation in Qur'an School includes possible exposure to and illness, injury, or death from infectious diseases including COVID-19. By sending your child to Quran school, as a parent you agree to release, exonerate, discharge and hold harmless the ICEV-Qur'an School, its Board of Directors, the individual members thereof, and all administration, teachers, volunteers, and representatives from all liability, claims, causes of action, or demands, including attorney fees, fines, fees, or other costs (e.g. medical costs) arising out of any exposure to or illness or injury from an infectious disease including COVID-19, which may result from or in connection with your child’s participation in Qur'an School program. You also release ICEV-Qur'an School from all liability for any loss regardless of cause, and claims arising from the student's participation in the Qur'an School program. I am the parent/guardian named in this form and hereby acknowledge and accept this waiver.

Name

Qur’an Class Registration Form

STUDENT INFORMATION

Student 1

Student 2

Student 3

Student 4

Student 5

FAMILY INFORMATION

BANK INFORMATION

ALLERGY INFORMATION

Disclaimers and Waivers

Islamic Center of the East Valley

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