JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Masjid Ibrahim Maktab Registration Form
Please fill separate forms for each new or returning student
Deadline to submit form is September 4th 2023
Classes start on Tuesday September 5th
** Age limit for girls is 10
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student
*
New
Returning
Time Slot
*
5:00 pm - 6:30 pm
6:00 pm - 7:30 pm
Name of Child
*
Your answer
Age of Child
*
Your answer
Grade in School
*
Your answer
Gender
*
Male
Female
Name of Parent/Guardian
*
Your answer
Cell phone
*
Your answer
Email
*
Your answer
Address
*
Your answer
Emergency Contact Name
*
Emergency contact also be able to pick up kids if needed
Your answer
Emergency Contact Cell
*
Your answer
Does the student have any Allergy(ies), Permanent illness, disability, or any other medical conditions
*
YES
NO
Emergency Treatment Release If emergency treatment is required and none of the authorized adults listed on this form can be contacted, I hereby authorize the staff of Masjid Ibrahim(Bethany Musalla) to take my child to a hospital.
*
*
YES
NO
I hereby release/indemnify Masjid Ibrahim(Bethany Maktab ), its staff/Agents, affiliates, partners, teachers/Trust and volunteers against any form of damages/injury etc. during the above mentioned student’s attendance at, to and from the Maktab and waive any claim against the Maktab
*
*
Agree
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
