Braille Quran Check Out Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Assalamu Alaykum!

InshaAllah this message finds you all in the best of health and iman.

If you are interested in borrowing a braille Quran, please fill out the form below. Please know that each borrower may check out up to two sets at a time for a two week period.

Once we've received your request, we will do our best to process it as quickly as possible and notify you if the Juz you requested is currently available, if so we will contact you with information for when you can pick it up from the Education Department, or add you to the waitlist if it is currently checked out and notify you when it is available, inshaAllah.

Borrower's First Name

Borrower's Last Name

Borrower's Primary Phone Number

Borrower's Primary Email Address

Which Juz would you like to check out - Maximum 2 sets at a time

Juz 1 - 3

Juz 4 - 6

Juz 7 - 9

Juz 10 - 12

Juz 13 - 15

Juz 16 - 18

Juz 19 - 21

Juz 22 - 24

Juz 25 - 27

Juz 28 - 30

Are you able to pick up the book from ADAMS Sterling?

Yes

Clear selection

If you are not able to pick up the Quran from ADAMS Sterling, which branch would you prefer to pick up the requested Juz(s)?

ADAMS Ashburn

ADAMS Chantilly

ADAMS Fairfax

ADAMS Gainesville

Clear selection

Terms of Borrowing Braille Quran

I promise to honor and take care of any juz I borrow, and will ensure that it stays clean, and returned in the same condition I picked it up. *

Yes

Required

Thank you for taking the time to fill out this application!

InshaAllah we will be in touch soon! Have questions? Please contact our accessibility facilitator Yasmina at yasmina.lahlou@adamscenter.org.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms