Quran Memorization Classes for Adult Brothers RegistrationQuran Memorization Classes for Adult Brothers Registration. Student Name: Age: Student Name 2: Age 2: Student Name 3: Age 3: Student Name 4: Age 4: Student Name 5: Age 5: Phone number:Email address: Home address:Any Allergies? ---NoYesIf yes state the details: Any medical conditions, or Behavioral issues:---NoYes State the condition: I, ,do not hold the IECPA or Tajan Quran Institute staff and volunteers responsible for any harm or injury to me during the time they are on the premises of the Islamic Education Center, located at 6635 Tilghman Street, Allentown, PA 18106. I will further comply with the rules and regulations set by the Tajan Quran Institute of IECPA. I hereby allow the staff and/or volunteers of the Tajan Quran Institute of the IECPA in the case of an emergency to me to administer CPR, First aid and/or contact emergency personnel or to take me to an Emergency Room in which case I will be fully responsible for the costs of the given treatments and/or emergency care fees. Class platform choice:OnlineIn Person I agree! that tuition payments are due by the fifth of every month and once the payment is late then I will have to pay for three months in advance in order for our child or for me to be able to continue attending classes.