Hifzul Quran

Mon–Fri · 5:30 PM – 7:30 PM

Full Quran memorization track with one-on-one teacher guidance. Mon–Fri after-school program.

Today

$100 registration & book fee

+ $100/month tuition · payable in first week of each month (collected separately)

Students

Student 1

Full name

Date of birth

Age

Sex

Returning student

Parents / Guardians

One parent's details is enough — name plus either phone or email.

Father

Name

Phone

Mother

Name

Phone

Address

Street address

City

State

Zip

Emergency contact

Name

Relationship

Home phone

Cell phone

Health information

Check any that apply so teachers can respond appropriately:

AsthmaHeart diseaseEpilepsyAllergy

Other (please describe)

Mental or physical handicap?

Any sight or hearing impairment that requires attention?

Consent & Signature

Terms and Conditions 1. Class Schedule: Classes are held Monday to Friday from 5:30 PM to 7:30 PM. 2. Tuition Fee: The monthly tuition fee is $100. Payment is due during the first week of each month. 3. School Rules: All school rules must be adhered to at all times. 4. Release and Waiver: I, the undersigned, consent that my child (the "Applicant") may participate in all DHIC Masjid and Hifz School activities. I hereby release and discharge the masjid and its officers, employees, volunteers, and agents from any claims for damages related to personal injury, death, property damage, or emotional harm arising from participation in these activities, except where non-waivable by law. 5. Indemnification: I agree to indemnify and hold the masjid and its representatives harmless for any loss, liability, cost, or expense incurred due to my child's participation in programs and activities on the premises. I HAVE READ THIS AGREEMENT, WAIVER, AND RELEASE THOROUGHLY, AND I FULLY UNDERSTAND ITS CONTENTS. I ACKNOWLEDGE THAT THIS IS A LEGALLY BINDING DOCUMENT AND A RELEASE OF LIABILITY, CREATING A CONTRACT BETWEEN MASJID, MYSELF, AND THE APPLICANT. I AM SIGNING THIS OF MY OWN FREE WILL. IF ANY PROVISION OF THIS AGREEMENT IS FOUND TO BE UNENFORCEABLE, IT SHALL BE SEVERABLE, AND THE REMAINING PROVISIONS WILL CONTINUE TO BE ENFORCEABLE.

I have read this agreement and consent on behalf of my child. I understand this is a legally binding release of liability.

Signature — type your full legal name

By typing your name and submitting, you are electronically signing this form. Your signature, the date, and your IP address will be recorded for our files (E-SIGN Act).

The masjid office will contact you to collect the $100 registration fee in person before the first class. You'll receive an email confirmation now.