Teen Ramadan Prep Program
Child's name and age *
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Child's date of birth *
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Primary parent's name *
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Primary parent's phone number *
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Primary parent's Email *
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Other parent's name *
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Other parent's Email *
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Other parent's phone number *
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Emergency Contact Name and Phone Number *
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Does your child have any food allergies or specific medical conditions? *
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RELEASE OF LIABIALTY AGREEMENT: In case of accident or injury we, the guardian, authorize the school staff to call an ambulance service if required, in order to obtain urgent medical care. M.A.G.R. and Rockford youth empowerment is NOT responsible for any accident or injuries to my child(ren) while under the supervision of the school. We hold M.A.G.R. and Rockford youth empowerment members harmless of any liability arising out of the operation of the school. *
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