Name*

First Name

Last Name
Date of Birth

Email*
Contact Email Address
Phone Number
Student or Parent Cell Phone
(Required) Level of Competition willing to participate in: Note: to accommodate particpiants for level 1, 2 and 5, candidate will select the Juzs that he memorize. Selected Juz don’t have to be in order.*









Name of Selecet Juz:
(Level 1,2 and 5)
Parent/Guardian Information
Father's Name
Mother's Name
Contact Email
parent contact info
Address

Address 1


Address 2

Country

City

Province

Postal Code
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application may result in my disqualification.*