ICC Ramadan Children's Program Registration

We are pleased to provide a Children's program for Children 0-10 years old. Children must be 10 years of age or less to participate.

30 days of Ramadan: $30

2nd child - $25 (Pre-paid students are given
3rd child - $15 preference if classes are full)
4th child - free


Daily/Drop-ins Rate: $2 per night/child

PAY HERE:: http://tinyurl.com/ChildrensProgram2017

Father's Name *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Mother's Name *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Child #1 - Full Name *
Your answer
Child #1 - Age *
Your answer
Child #1 - Gender *
Child #2 - Full Name
Your answer
Child #2 - Age
Your answer
Child #2 - Gender
Child #3 - Full Name
Your answer
Child #3 - Age
Your answer
Child #3 - Gender
Child #4 - Full Name
Your answer
Child #4 - Age
Your answer
Child #4 - Gender
Do any of your children have any medical concerns or allergies we should be aware of? Please list name of child and medical condition/medicine needed or allergies by their name) *
Your answer
Approved Individuals to Check Out Child (Please list Full Name and Relation to Child)
Your answer
WAIVER: By registering your child for the ICC Ramadan Children's Program, you must agree to the following conditions: 1. Be on time (start of Isha prayer) Parents must provide payment, sign in and out in the babysitting room and pick up their child if under the age of 4 years old, unless siblings over 18 years of age. 2. Respect all teachers and volunteers. Follow the rules and policies of ICC 3. Pick up your child within 15 min of witr finishing. If you do not pick up your child on time, after the 3rd time your child will not be allowed to attend classes. Ages 7-10 will be released after witr is finished.I, the attendee understand that the ICC reserves the right to dismiss anyone, in their opinion, is a hazard to the safety or rights of others, or who appears to have rejected the reasonable expectations of the Masjid and the Ramadan program.I hereby give consent for me and/or my child to participate in the full program and all activities including surveys used for the purpose of future programing unless I advise you in writing. I give permission for ICC to use any photograph of me and/or my child for promotional material. To the best of my knowledge, I and/or my child are in good health and I will notify ICC if he/she is exposed to any infectious diseases. I further release and agree to indemnify and hold harmless ICC, employees, volunteers or assigns from any liability concerning my and/or our child’s involvement in the ICC Ramadan Activities. In case of medical emergency, I hereby give permission to the physician selected by ICC and its employees and volunteers to hospitalize, to secure proper treatment for, and to order injection, anesthesia, or surgery for my child, as named on this form. Every effort will be made to contact the parent/guardian in the case of emergency. *
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