2026 ICCNY Summer School Program
Please complete this form by filing in all fields. Leaving anything blank may delay or prevent your child(ren) from being enrolled. Type the word "none" if the item does not apply for any reason. If you are trying to enroll a child(ren) that is not in your legal custody (i.e. a neighbor's, a friend's, or a family member's child) please complete a separate form for that(those) child(ren) with their parent or legal guardian's information. If you want to enroll more than three children, you will need to complete multiple forms. Filing this form does not guarantee entry! It is the respondent's responsibility to ensure information is correct and complete.
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1. Mother's First Name *
2. Mother's Last Name *
3. Father's First Name *
4. Father's Last Name *
5. Home Address (Ex. 1234 Maple Street Apt 20, Queens, NY 55555) *
6. Email address *
7. Contact Phone Number(s) (Separate multiple numbers with "/") *
8. Is this the first time the child(ren) will be enrolled in the ICCNY Summer or Weekend School Program? *
9. (A) Child's First Name *
10. (A) Child's Last Name *
11. (A) Child's Gender *
12. (A) Child's Date of Birth *
Only children born between 2009 and 2021 are being considered at this time.
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DD
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13. Does this child have any allergies? If yes, to what? *
14. (A) Child's Grade *
15. (A) Child's Number of Qur'anic Chapters (Surah) Entirely Memorized *
Stop after this question if you are only applying for one child.
16. (B) Child's First Name
17. (B) Child's Last Name
18. (B) Child's Gender
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19. (B) Child's Date of Birth
Only children born between 2009 and 2021 are being considered at this time.
MM
/
DD
/
YYYY
20. Does this child have any allergies? If yes, to what?
Clear selection
21. (B) Child's Grade
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22. (B) Child's Number of Qur'anic Chapters (Surah) Entirely Memorized
Stop here if you are only applying for two children.
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23. (C) Child's First Name
24. (C) Child's Last Name
25. (C) Child's Gender
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26. (C) Child's Date of Birth
Only children born between 2009 and 2021 are being considered at this time.
MM
/
DD
/
YYYY
27. Does this child have any allergies? If yes, to what?
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28. (C) Child's Grade
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29. (C) Child's Number of Qur'anic Chapters (Surah) Entirely Memorized
Stop here if you are only applying for three children. Complete a second form if you have more than three children from one family to enroll.
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30. Are there any notes that you want to include about any child(ren) on this form? (i.e.: neurodivergence, IEP status, unique social emotional habits, additional questions, etc.)  If not, please type "None". *
Information

ICCNY Summer School Program 2026

Start Date: Saturday, July 25, 2026

Time: 9am - 12pm

Days: Saturdays - Tuesdays

Ages: Children Born 2009 - 2021

Classes: Arabic, Qur’an, and Islamic Studies

Absence: No more than 3 days (includes absences due to tardiness)

Tardiness: No entry later than 9:45am

End Date: Tuesday, September 1, 2026


Agreement
I/We (parents, guardians, and/or family named in this form) agree to the terms mentioned above. I/We understand that enrollment in the 2026 ICCNY Summer School Program will be based on previous enrollment status (if applicable), completion of an application, child(ren) eligibility as stated, and availability of space.
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