12/20 YM Juniors Registration
Asalamu Alaikum! We are so excited to be hosting another session of YM Juniors here at ICMC. Please keep in mind that this is a drop-off only program and no parents will be allowed to stay for the duration of the program. This program is strictly for boys and girls ages 7-13.

Date:
December 20, 2019

Time:
Boys and girls: 6-8PM

Address: 336 Lawrence Station Road, Lawrenceville NJ 08648

***If you have more than one child attending, please fill out the form separately for each child.

By filling out this registration form, you agree that the volunteers and staff at ICMC can not be held accountable for any injuries or accidents that happen throughout the duration of the program.
Parent's Name (First and Last): *
Your answer
Parent's Phone Number: *
Your answer
Parent's Email: *
Your answer
Child's Full Name *
Your answer
Child's Age (Ages 7-13 ONLY): *
Your answer
Child's Date of Birth: *
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Gender *
Does your child have any allergies? If so, what type of allergies?
Your answer
Does your child have any physical limitations or medical conditions that we should be aware of or will they be requiring one-on-one assistance by one of our MUHSEN trained volunteers? (Please specify which)
Your answer
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