Al Iman Summer Camp Registration
Please complete the following Summer Camp Registration. Please note: For registration to be complete, payment must be made to Al Iman School. The cost is $90/week. Payments can be made by check or cash and must include total number of weeks you have registered your child. No refunds will be issued.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
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Age of child *
Your answer
Child #2 First Name
Your answer
Child #2 Last Name
Your answer
Child #2 Date of Birth
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YYYY
Child #2 Age
Your answer
Child #3 First Name
Your answer
Child #3 Last Name
Your answer
Child #3 Date of Birth
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DD
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YYYY
Child #3 Age
Your answer
Home Address *
Your answer
Home Phone Number *
Your answer
Father's Full Name *
Your answer
Father's Cell Number *
Your answer
Father's e-mail *
Your answer
Mother's Full Name *
Your answer
Mother's Cell Number *
Your answer
Mother's email *
Your answer
Emergency Contact Name #1 *
Your answer
Emergency Contact Phone Number #1 *
Your answer
Relationship to Child *
Your answer
Emergency Contact Name #2 *
Your answer
Emergency Contact Number #2 *
Your answer
Relationship to Child *
Your answer
Which weeks would you like to register your child? Click all that apply. Please note: payment for weeks checked must be provided to complete registration. Payment can be made at Al Iman School. *
Required
Does your child have any allergies? *
Please indicate allergies:
Your answer
I acknowledge and agree that Al Iman School may take photographs and video of individuals or groups participating in programs and events and may use any photographs(s) and/or video taken of me or my child to publicize the program. *
I understand that participating in the summer camp program involves risk of injury or illness. These risks include, but are not limited to, inclement weather, accidents while traveling, food related illness. By selecting "agree", I acknowledge all risks of injury and affirm that I have assumed all responsibility of injury. I also agree for myself and for any child participant to follow all rules and procedures of the program and to follow the reasonable instructions of the teachers and supervisors of the program. If my child does not adhere to rules and procedures, they will be withdrawn from the summer camp. *
Parent Signature *
Your answer
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