Dar Al - Sunnah 2022 Summer Camp Registration
Kids Summer Camp
Mon -Thur 10AM - 2PM

Session 1: July 4 - July 28
Session 2: August 1 - August 26

Boys Ages 10+ will be separated from girls

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Child's full name: *
Child's Birthdate:         (MM, DD, YYYY) *
Child's Personal Healthcare Number: *
Child Medical Concerns
Parent/Guardian Full Name: *
Parents Phone Number: *
Emergency Contact  1 Name *
Emergency Contact 1 Phone Number: *
Emergency Contact 2 Name: *
Emergency Contact 2 Phone Number: *
Email *
Address *
I would like to register my child/ children for the following weeks:  Session 1: July 4th   -  July 28th
I would like to register my child/ children for the following weeks: Session 2: August 1st - August 26th                                                    
Waiver – Please read and sign below:    
I, (the Parent/Guardian), of the child(ren) listed above am leaving my child(ren) with the summer program held at Dar Al Sunnah Mosque and hereby release and waive against all claim of Dar Al Sunnah Mosque, its agents, employees, volunteers, representatives, officers, directors, from injuries, damages arising from injuries relating to my child(ren) participation in the summer program at Dar Al Sunnah Mosque. I further agree to indemnify, save and hold Indemnities harmless from any loss, liability, attorney fees, damage or cost that they (or any of them) may incur out of or related to the summer program offered by Dar Al Sunnah Mosque. In the case of a medical emergency or behavioral issues, I understand that the staff at the summer program will act on my behalf if attempts have been made to contact me and I wasn’t available. By signing below I acknowledge the information above is correct and agree to the waiver stated above.

Please sign with your initial Jazakallah: *
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