Program Registration ~ MOHID ©

Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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Tarteel Academy Part-Time 2023-2024 Registration

11
SEP

29
AUG

Program Fee:

One Time: $25.00

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1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Child's Full Name (First & Last)*

Child's DOB *

Child's Grade in School *

Parents FULL Name (First&Last) *

Parent Phone Number*

Parent Email*

Address *

How did you hear about our program?*

Does your child have allergies?*

Pre-existing health conditions?*

Does your child have an IEP?*

Has your child attended classes in the masjid before?*

I understand bus fee is paid separately*

Do you want bus service? (extra $150 per family) *

Has your child done Hifdh before?*

Can your child read Arabic fluently?*

I understand that this is a evaluation application *

I understand my child needs to be evaluated first *

I understand that acceptance in the program isn't guaranteed*

I understand that this program is a great commitment*

Do you plan to come Sept 9th or 10th for evaluation?*

+ Add More Registrants

3 Tarteel Academy Part-Time 2023-2024

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering, you acknowledge that you will follow all the instructions provided to you by the Masjid and that you read everything carefully before paying.

Islamic Center of Staten Island

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Tarteel Academy Part-Time 2023-2024 Registration

1 Contact Information

2 Add Registrants

3 Tarteel Academy Part-Time 2023-2024

Payment Summary

Acknowledgement

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