EIC-WIS Youth 2019-2020 Registration Form
Registration from Waitlist: EIC Weekend Islamic School for YOUTH ages 12 to 18 years will be on Fridays 7pm-8pm from August 30, 2019 to April 10, 2020. Please submit this form for each child and pay the total EIC-WIS Tuition (tuition: $300/year; sibling: $270).
Email address *
Student's Full Name *
Your answer
Gender *
Current Age *
EIC-WIS Youth for ages 12 - 18 years.
Your answer
Birthdate *
format: mm/dd/yyyy
Your answer
Home Address *
format: street address, city, zip code
Your answer
Father's Full Name *
Your answer
Father's Email Address *
Your answer
Father's Mobile Number *
Please include area code
Your answer
Mother's Full Name *
Your answer
Mother's Email Address *
Your answer
Mother's Mobile Number *
Please include area code
Your answer
Does your child have any allergies or special needs that we should know about? *
If none, type "No". If yes, then please explain.
Your answer
Emergency Contact 1 *
format: full name & phone number [someone who is allowed to pick up your child in case both parents are unavailable]
Your answer
Emergency Contact 2 *
format: full name & phone number [someone who is allowed to pick up your child in case both parents are unavailable]
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service