Shine With Deen
Parent / Guardian Program Registration
1. The children that I am registering are ages 9-13 years at the start of Ramadan 2018. *
Required
2. I agree to pay a nonrefundable registration fee of $15.00 per child or $30 per family to reserve a slot for attendance in the program. *
Required
3. I agree to pay a non-refundable, nightly fee of $5 per child, due at the time of drop-off. *
Required
4. I agree that I will pick-up my child/children within 15 minutes after the completion of the 8th rakat of taraweah. *
Required
5. I agree to sign my child/children in and out each night and include a working cell phone number to be contacted in case of emergencies. *
Required
6. I agree that the individual I assign to sign in my child at drop-off will be the same individual who will sign out my child for pick-up. *
Required
7. I understand that the administrators of “Shine with Deen” reserve the right to remove my child from the Youth Program for any good cause which includes but is not limited to: late pick up of my child, behavior issues or failure to comply with program policies. *
Required
8. I understand that only receipt of payment will reserve a slot in the program. Please pay with cash or check at the first drop-off. *
Required
Parent/Guardian Printed Name *
Your answer
Please sign below acknowledging the agreements above and the intention to abide by the rules set forth. (Electronic) Parent/Guardian Signature *
Your answer
Phone Number *
Your answer
Email *
Your answer
Name of Child 1 *
Your answer
Age of Child 1 *
Your answer
Name of Child 2
Your answer
Age of Child 2
Your answer
Name of Child 3
Your answer
Age of Child 3
Your answer
Name of Child 4
Your answer
Age of Child 4
Your answer
Name of Child 5 (if you have more than 5 children please fill out a second registration form)
Your answer
Age of Child 5
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service