Taqwa Youth Educational Program
1. Fill out this application for each one of your children.
2. Monthly fee is $25 per month per student.
3. For support, contact Imam Zaid (787 629-7574) / Br. Sadat (407 791-7720)
Student's first name: *
Your answer
Student's last name: *
Your answer
Student's gender: *
Student's age *
Your answer
Student's grade (in regular school) *
Your answer
Parent's / Guardian's first and last name: *
Your answer
Parent's / Guardian's contact number *
Your answer
Parent's / Guardian's emergency contact number *
Your answer
My child needs special assistance (medical) *
Parent's / Guardian's e-mail address (optional)
Your answer
Survey 1: What days do you suggest Taqwa weekend educational program be? *
Survey 2: What time should Taqwa weekend educational program be? *
Survey 3: Are you interested in the after-school program: Mondays – Thursdays from 5:30 pm to 7:30 pm? *
Waiver
Attendance/Pick-up/Drop-off at the Islamic Center of Osceola County (Masjid Taqwa, herein) is the full responsibility of the parent/guardian and does not constitute any liability for Masjid Taqwa. As the parent/guardian, I acknowledge that I will NOT seek Masjid Taqwa held liable if any accident, injury, loss of property or any other circumstance or incident occurs during or because of my son’s/daughter’s participation in Masjid Taqwa activities. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from my son’s/daughter’s participation in Masjid Taqwa events. I hereby release and agree to hold harmless Masjid Taqwa, its officials, agents and employees, from any claims arising out of my son’s/daughter’s participation in those event(s). I have read and understand and accept all the statements recited above and accept full responsibility as described.
Waiver agreement: *
Required
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