Zidney ILMA School - Registration Form
SUMMER SEMESTER: MAY 28-AUG. 20
Family Name, First Name
Your answer
Address
(Street #, Unit #, City, Postal Code)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Home Phone
Your answer
Medical Alert Information/Disability/Allergies:
Your answer
Language(s) spoken at home
Your answer
First Language
Your answer
Level of spoken Arabic
Level of written Arabic
Parent/Guardian's Name
Last Name, First Name
Your answer
Parent/Guardian's Cell Phone
Your answer
Parent/Guardian's Email Address
Your answer
Emergency Contact Information
Other than parent/guardian
Your answer
Emergency Contact Relationship to Student
Your answer
LEGAL DISCLAIMER
Please note, by submitting the application, the Parent/Guardian agrees to the following:
"I desire my child to participate in the full Sunday School program and all the activities, unless I advise you otherwise in writing. The organizers will endeavour to make all activities as safe as possible for all participants. However, in the case of injury to my child, I will not hold the organizers, staff, Zidney School, Sanad Collective or the Rhoda Institute liable.
To the best of my knowledge, my child is in good health and has not been exposed to any infectious disease in the past four weeks. If my child becomes exposed to any infectious disease between now and any session of Zidney School, I understand the organizers must be notified. In case of surgical emergency and should I not be immediately available for consultation, I hereby give permission to the physician selected by the School Director (Shehnaz Karim), to hospitalize my child, secure proper treatment, order injections, anaesthesia or surgery for my child, as above.
I agree to the legal disclaimer above
Required
PHOTO WAIVER
I hereby grant the organizers of Zidney Ilma School permission to use my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Zidney School and will not be returned.

I hereby irrevocably authorize Zidney School to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child's likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Zidney Ilma School, Sanad Collective, and the Rhoda Institute from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I agree to the photo waiver above
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