Under the Spiritual Guidance of

His Eminence Allama Arshadul Quadri

Registration

REGISTRATION FORM

Hijaz Foundation of America, Inc

Jama Mecca Masjid

15001 beechnut St, Houston TX 77083

HIJAZ WEEKEND SCHOOL

Student Details

First Name

Last Name

Date of Birth

Grade Level

Address

City

State

ZipCode

Home Phone

Cell

Parent/Guardian Details

First Name

Last Name

Applying for Course Name

Mode of payment

By Check By Cash By Check-o-matic

Emergency Contact Person

Cell

Primary Care Doctor

Cell

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

Student Signature

Date

Parent Signature

Date