Summer Camp (2019) Registration Form
🔸Registration fee $ 15/-

🔸Payment can be made via:
(1) etransfer by emailing - taleemweekendschool@gmail.com
(2) cash or
(3) cheque*
* mailing address for cheque: 5569 Caprigate Mississauga.

🔸Please note: spots will not be confirmed until payment is done.

Student Information
Name *
Your answer
Gender *
Birth Date *
MM
/
DD
/
YYYY
Grade *
Your answer
School Name *
Your answer
Home Address *
Your answer
City *
Your answer
Province *
Your answer
Postal Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Any medical concerns? If yes, please give detail. *
Your answer
Family Information
Father's Name and Phone Number *
Your answer
Mother's Name and Phone Number *
Your answer
Any siblings enrolled in Taleem Academy classes? If yes, please add their name and grade. *
Your answer
Emergency Contact Name (not living at same address) *
Your answer
Emergency Contact Phone Number *
Your answer
How did you hear about us? *
Your answer
Waivers
Photography - I agree to give Taleem Academy permission to take pictures of my child while participating in the various programs and activities at the Taleem Academyto be used solely for the purpose of advertisement and promotion in the future. *
I understand and agree that Taleem Academy shall not be held responsible for any medical costs incurred in any situation. I understand that I am financially responsible for any medical costs incurred. I agree to release and not indemnify Taleem Academy, its staff and volunteers from any injuries, verbal or physical mistreatment incurred to the applicant. Taleem reserves the right to cancel the registration if rules and policies of the school are not followed. *
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