Evening Quran Program & Part Time Hifz Registration Form Monday – Thursday | 5PM- 8PM Registration Form Program SelectionWhich program are you applying for?*Evening Quran ProgramPart-Time HifzSection A: Applicant’s InformationFirst Name*Last Name*Date of Birth*Age*Gender*Please selectMaleFemaleAddress Line 1*Address Line 2City*Province*Postal Code*Primary Phone Number*Secondary Phone NumberEmail Address*Section B: Parent's/Guardian's InformationParent 1Last Name*First Name*Relationship*FatherMotherGuardianCell Phone*Email*Parent 2Last NameFirst NameRelationshipFatherMotherGuardianCell PhoneEmailSection C: Emergency Contact InformationEmergency Contact Name*FirstLastRelation with the Student*Cell Phone* Section D: Medical InformationPlease list all medical conditions that may impact your study at AlManarat Academy or that may require attention while you are on campus. If there are none, please enter N/A*Health Card Number*Version Number*Section E: Fee Information Evening Quran Program: $75 per month Part-Time Hifz: $125 per month Payment Method: Interac e-Transfer fee to caringalmanarat@gmail.com You will be required to email money transfer the total fee amount to caringalmanarat@gmail.com after submitting the registration form to confirm your spot. Section F: Enrolment Agreement Declaration*MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT : Personal information on this form is collected under the legal authority of the Education Act, R.S.O. 1980, c.129 and Health Card Numbers Control Act, 1991. This information will be used for the purposes of: processing student registration, production of student databases, student placement and referrals, statistical and reporting requirements by the Ministry of Education, program to students, contacting parent(s), guardian(s), etc., in case of emergency, and the disclosure of health related information to the Medical Officer of Health. Questions regarding this collection and use of personal information should be directed to the Administration Office.I take full responsibility to enroll my Child at Al Manarat AcademyI am financially responsible for his/her fees and expensesPARENT'S / GUARDIAN'S SIGNATURE*Date*SendThis field should be left blank