Bismi’llahir Rahmanir Raheem

  

                                                                                                                                                 

 

Al-MuslimaatAcademy

Double Dutch

Jump Rope Contest

                                                                                          

                

Registration Form

 

 

Name:_________________________________________________________________________________________

 

 

Address:_____________________________________________________________________________________

 

 

City:__________________    State:___________    Zip Code:_______________

 

Telephone Number:__________________________   Cell Phone: __________

Email Address:_____________________________________________________

 

 

Contestant Registration Fees

                                     Child (Age 5-12)……………………..……………………$ 8.00

                                  Youth (Age 12- 17)……………………………………………$15.00

                                  Adult (18 and Up)………………………………………………$20.00

 

 

Acceptable Form of Registration Payment:  Money Order Only

  Make payment payable to: Al-Muslimaat Academy

 

Return Registration form to:    

Al-Muslimaat Academy

Attention: Sister Lisa Muhammad

35 Finlay Place

Newark, New Jersey 07106

 

Please Print and Fill-in