Registration Form test page

Please select your main program:

Please fill in student information:

  • Father's full name:
  • Phone#:
  • Email Address:
  • Mother's full name:
  • Phone#:
  • Email Address:
Email Address:


If yes state the details:

I, , do not hold the IECPA or Tajan Quran Institute staff and volunteers responsible for any harm or injury to my son/ daughter during the time they are on the premises of the Islamic Education Center, located at 6635 Tilghman Street, Allentown, PA 18106.

I will be fully responsible for any and all damages and/or vandalism that are caused to the building, classrooms, supplies or equipment used by staff that would have been caused by any negligence or abuse by my children. My child (or children) and myself 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 one or more of my children to administer CPR, First aid and/or contact emergency personnel or to take my child to an Emergency Room in which case I will be fully responsible for the costs of the given treatments and/or emergency care fees.


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.