Weekend Maktab A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator. Student Information Student 1 First Name Middle Name Last Name Today Age2 Date of Birth Gender Male Female Add another student? Yes No Student 2 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Add another student? Yes No Student 3 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Add another student? Yes No Student 4 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Add another student? Yes No Student 5 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Add another student? Yes No Student 6 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Add another student? Yes No Student 7 First Name Middle Name Last Name Age Date of Birth Gender Male Female Previous Islamic Education: Street Address Apt/Unit City State Zip Code Home Phone Parent/Guardian Information Parent/Guardian 1 Parent/Guardian Name Relationship Father Mother Guardian Same as Student's Address? Yes No Street Address Apt/Unit City State Zip Street Address Apt/Unit City State Zip Email Address Cell Number Parent/Guardian 2 Parent/Guardian Name Relationship Father Mother Guardian Same as Student's Address? Yes No Street Address Apt/Unit City State Zip Street Address Apt/Unit City State Zip Email Address Cell Number Emergency Contact Information Emergency Contact Name Relationship Father Mother Guardian Same as Student's Address? Yes No Street Address Apt/Unit City State Zip Street Address Apt/Unit City State Zip Email Address Cell Number Guidelines Parents are not allowed to stay inside the building during the Maktab hours. All fees should be paid electronically by providing the bank details. No cash will be received towards the fees. Parents need to contact the administration to get an appointment with a teacher. No walk-ins allowed to discuss the progress of a child. Ages allowed for Maktab will be between 5 years to 12 years. All families should abide by Darul Arqam Discipline policy provided on the portal. Maktab working days will be based on Darul Arqam Islamic School calendar. Tuition ACH Authorization Form Please Check the box to Agree on Class Duration Sat & Sun 10:00 AM to 12:30 PM Tuition Fee : $75 Account Holder's Information: First Name Middle Name Last Name Same as Parent/Guardian Address? Yes No Street Address Apt/Unit City State Zip Street Address Apt/Unit City State Zip Street Address Apt/Unit City State Zip Electronic Check Withdrawal Information Type of Account Checking Saving Credit Card Bank Name Bank Routing # Bank Account # Card Type Visa Master Card Other Name On Card Card Number Expiration Date 3 Digit Code Terms and Conditions I hereby authorize Darul Arqam Center of Excellence to initiate debit entries to the checking/savings account indicated above at the Financial Institution named, in the amount of the payment due and to make the deduction payable to Darul Arqam Center of Excellence. A record of each ACH transaction will be included in my regular bank statement and will serve as my receipt. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U. S. law. Any returned ACH payments will be charged a $25 service fee, which will be billed to you on your students’ monthly incidental billing. This payment plan is to remain in effect until the payment plan ends or is cancelled by the participant in writing within at least five business days before the next scheduled withdrawal date. The participant may terminate the agreement at any time by submitting written notice to the Darul Arqam Center of Excellence Business Office. Termination from the agreement on the family’s part will not release the family of any financial obligation to the school. Questions or concerns regarding any of these terms and conditions should be directed to the Office at 612-758-0501. I Agreed to the terms and conditions Parent/Guardian Name Submit
