DUS Islamic Education for Children

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DUS Islamic Education for Children

Registration Form

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Email *

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Parent's Name (Last, First): *

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Street Address: *

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Apartment/ Unit:

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City, State, ZIP Code *

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Cell Phone Number: *

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Email Address: *

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Emergency Contact: *

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Student Name (Last, First, MI): *

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Date of Birth: *

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Gender: *

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Special Needs? *

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If you have selected "Yes" as the answer to the previous question, then please indicate the types of accommodations needed.

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