Program Registration ~ MOHID ©

Islamic Center of Staten Island

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

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Inara Academy 2024-2025

16
SEP

12:00 AM

15
JUN

12:00 AM

Program Fee:

One Time: $500.00

View Details

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 *

Child's DOB (mm/dd/yyyy)*

Child's Grade in School (3K-12th)*

Is your child a returning student?*

Weekday (3K-12th) or Weekend (3K-8th)?*

Will your child need bus service?*

Allergies?

Autism or Learning Disabilities?

Health Conditions?

FULL Address

Parent FULL Name

Parent Phone Number

Parent Email

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Email *

Anything else we should know?

If registering 2 Kids , Use promocode 2kids

If registering 3 Kids , Use promocode 3kids

If registering 4 Kids , Use promocode 4kids

If registering 5 Kids , Use promocode 5kids

I understand the price includes book fees ($50/child)

+ Add More Registrants

3 Inara Academy 2024-2025

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.

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Payment Summary

Program Fee

Total Registrants

Total Cost

Islamic Center of Staten Island

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Inara Academy 2024-2025

1 Contact Information

2 Add Registrants

3 Inara Academy 2024-2025

Payment Summary

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