Registration

Hijaz Foundation of America, Inc
Jama Mecca Masjid
15001 beechnut St, Houston TX 77083
HIJAZ WEEKEND SCHOOL

Name of Student:

Last

First

Date of Birth:

Grade Level:

Address:

City:

State:

Zip:

Home Phone:

Cell:

Parent/Guardian:

Applying for Course Name:

Mode of Payment of Free:By CheckBy CashBy Check-o-matic

Emergency Contact Person:

Cell:

Emergency Contact Person:

Cell:

Primary Care Doctor:

Cell:

I,(student name) will abide by the rules and regulations of Hijaz Weekend School.

Student Signature[signature* signature-120 id:sign class:sign]

Date

Parent Signature[signature* signature-121 id:sign1 class:sign]

Date