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Worcester Islamic Center

248 East Mountain Street, Worcester, Massachusetts 01606, USA

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Al Itqaan Sunday School

17
SEP

30
JUL

Program Fee:

One Time: $1,300.00

Monthly: $325.00 (Number of Months: 4)

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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

Student First and Last Name*

If more than one child write other student(s) full name

Parent/Gurdian Name*

First Student Date of Birth

Date of Birth of Student (s) 2, 3, 4 etc.

Do you have a WhatsApp Account-Yes or No*

Did your child attend Sunday School Last year? Yes, or No*

If yes to above indicate which level (1A, 1B,1C,1D,2,3,4,5)

Emergency Contact (Name, Phone#)*

Do you want to volunteer for the Sunday School? Yes or NO

Total number of children you are registering (1, 2 3, 4 etc)*

+ Add More Registrants

3 Payment

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

Payment Method

eCheck/ACH titleIcon

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 Worcester Islamic Center consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

Agree Decline

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

Please note that this application does not guarantee admission. We will contact you to complete registration. 1. I agree that my child will be dressed as ready for prayer. 2.I am committed with my child to following the rules. 3. I am committed to privately share any special needs for my child and I understand that Al Itqaan may not have the adequate resources for my child.

Worcester Islamic Center

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Al Itqaan Sunday School

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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