Al Furqan Learning Centre
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Student Information Form
Step
1
of
2
50%
Are you a Parent or Guardian?
(Required)
Parent
Guardian
Parents / Gurdian Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
Street Address
City
Postal Code
How many kids are planning for tution?
(Required)
1
2
3
4
5
1st Student Information
Name
(Required)
First
Last
Date of birth
(Required)
MM slash DD slash YYYY
Grade
(Required)
1
2
3
4
5
6
7
8
9
10
School Name
(Required)
Subject of interest
(Required)
Math
English
Social Studies
Science
Availability (days/times) for tutoring
2nd Student Information
Name
(Required)
First
Last
Date of birth
(Required)
MM slash DD slash YYYY
Grade
(Required)
1
2
3
4
5
6
7
8
9
10
School Name
(Required)
Subject of interest
(Required)
Math
English
Social Studies
Science
Availability (days/times) for tutoring
3rd Student Information
Name
(Required)
First
Last
Date of birth
(Required)
MM slash DD slash YYYY
Grade
(Required)
1
2
3
4
5
6
7
8
9
10
School Name
(Required)
Subject of interest
(Required)
Math
English
Social Studies
Science
Availability (days/times) for tutoring
4th Student Information
Name
(Required)
First
Last
Date of birth
(Required)
MM slash DD slash YYYY
Grade
(Required)
1
2
3
4
5
6
7
8
9
10
School Name
(Required)
Subject of interest
(Required)
Math
English
Social Studies
Science
Availability (days/times) for tutoring
5th Student Information
Name
(Required)
First
Last
Date of birth
(Required)
MM slash DD slash YYYY
Grade
(Required)
1
2
3
4
5
6
7
8
9
10
School Name
(Required)
Subject of interest
(Required)
Math
English
Social Studies
Science
Availability (days/times) for tutoring
