Registration for
AdultChildAdult and Child
Class location
UnsureAl Falah Islamic CentreBrampton Islamic CentreDar-Ul-Hijra Islamic CentreDawanet Islamic CentreMilton Qur'an InstituteSalaheddin Islamic CentreSayeda Khadija Islamic Centre

1. PARENT Information / ADULT Registration

First name

Last name

Gender M/F
MaleFemale
Home phone number


Cell phone number


Email

Street address

Unit/Apt Number

City

Province

Postal Code

Emergency contact name

Emergency contact relation

Emergency contact phone number

2. STUDENT Information (please complete if registrant is under 18 years of age)

First name

Last name

Gender M/F
MaleFemale
Date of birth

OHIP#

First name

Last name

Gender M/F
MaleFemale
Date of birth

OHIP#

First name

Last name

Gender M/F
MaleFemale
Date of Birth

OHIP#

First name

Last name

Gender M/F
MaleFemale
Date of Birth

OHIP#

3. Health / other concerns:

4. CLASS REGISTRATION FEES:

a. Registration Fee:
- $75 initial registration fee per person (includes a uniform)

b. Monthly Fees:
- Individual - $55/month
- Family - $45 per student/month with 3 or more in the same family

c. FEES ARE DUE BY THE FIRST OF EACH MONTH

Number Of Students Registering12345

Initial Registration Payment
(+$2 Online Service Fee)
$77 (Individual registration)$77 (Family registration)

Monthly Fees
$55 (Individual)$45 (Family:3 or more in a family)

Total

Waiver
I agree to take lessons at United Muslim Martial Arts for tuition and arrangements as indicated herein. Non-attendance does not release me from my agreed payment. I understand that martial arts may be a dangerous sport. Every effort is taken to safeguard participants provided they follow instructions. Students must wear protective gear when sparring. United Muslim Martial Arts will not be responsible for students who leave the gym without the permission of the instructor. It is the parents’ responsibility to ensure their children are picked up promptly when the class has ended. I understand that United Muslim Martial Arts is not responsible for students once the class has ended. Neither United Muslim Martial Arts, nor any organizations, nor anyone associated with it, will be held responsible for any injuries, damages, claims, or demands arising out of participation of the person(s) so named in the program.

Select Paypal as payment method