Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Parents NameFirstLastLayoutEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSession Selection4PM - 5:30 PM5:30 PM - 7 PMLayoutMembership Status *MemberNon-MemberNumber of students Selected Value: 1 Student #1Student Name *FirstLastLayoutGenderBoyGirlAge Selected Value: 7 Grade Selected Value: 1 Student #2Student Name *FirstLastStudent 2GenderBoyGirlAge Selected Value: 7 Grade Selected Value: 1 Student #3Student Name *FirstLastLayout (copy) (copy)GenderBoyGirlAge Selected Value: 7 Grade Selected Value: 1 LayoutMHMA Members $120 $100 per month $35 book fees per student 25% sibling discount Non-Members $120 per month $35 book fees per student 25% sibling discount Additional Information / CommentFee Waiver Fee waiver for Zakat-eligible families is available (please email hidaya@mhma.info) Submit
