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Thank you for your interest in Islamic Center of Johnson County!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

If you are interested in more than one program (Sunday School, Camps, IQRA Institute), please fill out this Inquiry form again and select a different program grade level of interest.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Current School

  • Student Preferred Name (if not first name)
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •