Islamic Society of Tracy: Educational Programs Form

Please select one of the following class times:

Your child will be eligible to attend weekday classes only (Tuesday and Thursday*)

Fees:

• Option 1: $40/month/Student

• Option 2: $30.00/month membership + $10.00 for first child and $20 for each additional child (annual membership required)

Please circle your preferred timing you would like your child to attend:

Session 1: 5:00pm – 6:15pm Monday & WednesdaySession 2: 6:15pm – 7:30pm Monday & WednesdaySession 3: 5:00pm – 6:15pm Tuesday & ThursdaySession 4: 6:15pm – 7:30pm Tuesday & Thursday

Please fill in the information below:

Student(s) first and last names:

Parent first and last name:

Parent phone number:

Home Address:

City/State:

Zip Code:

Parent Signature:

Date:

Automatic Credit Card Payment Authorization

Card #:

Exp Date:

Name on Card:

Zip Code:

Will be charged on the 1st of every month until you call us to stop payment or your card is declined.

*Any changes in the class schedule will be sent home on a written notice.