Registration – Bilal Academy

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School Enrollment Form (#3)

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First Name

Middle Name

Last Name

Student Date of Birth

Student Gender

Student Gender

Boy

Girl

Student Medical Allergy

Phone

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Student Image Upload

Choose File

Add Sibling

Yes

First Name

Middle Name

Last Name

Date Of Birth

Gender

Medical Allergy

Sibling Phone/Mobile

Sibling Email

Sibling Address

Same As Student

No

Sibling Address

Address Line 1

Address Line 2

City

State

Zip Code

Sibling Image Upload

Choose File

Parent/Guardian (First Name)

Middle Name

(Last Name)

Parent/Guardian Company

Parent/Guardian Mobile Phone

Parent/Guardian Email

Add Parent

Yes

Parent/Gardian (First Name)

Middle Name

Parent/Guardian Address

Same As Student

No

Add Parent/Gradian Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Email

First Name

Last Name

Emergency Phone/Mobile

Enrolling Program

Sunday School & Youth Leadership Program

Summer Camp

Quran Memorization

Sunday School & Youth Leadership Program

First Child Monthly

First Child Full Tuition

Sibling Monthly

Sibling Full Tuition

family Of 3 Monthly

Family Of 3 Full Tuition

Max Family Monthly

Max family Full Tuition

Quran Memorization Program

First Child Monthly

First Child Full Tuition

Sibling Monthly

Sibling Full Tuition

family Of 3 Monthly

Family Of 3 Full Tuition

Max Family Monthly

Max family Full Tuition

Summer Camp

First Child Weekly

First Child Full Tuition

Sibling Weekly

Sibling Full Tuition

family Of 3 Weekly

Family Of 3 Full Tuition

Max Family Weekly

Max family Full Tuition

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Coupon

Apply Coupon

Payment Method

Pay with Card (Stripe)

Pay with PayPal

Pay with Card (Stripe)

Payment Method

Pay with Card (Stripe)

Pay with PayPal

Pay with Card (Stripe)

Pay via Zelle:

ZellePhone Number: (848) 986-7735
Registered Name: The Muslim Socity Of Jersey Shore
Please complete the Zelle transfer in your banking app before or after submitting this form.

Subscription to all Bilal Academy Programs

1 Student Family Monthly Plan

$99.99 for each month

2 Student Family Monthly Plan

$149.99 for each month

3 Student Family Monthly Plan

$195.99 for each month

Max Family Monthly Plan

$249.99 for each month

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