Arabic Immersion Summer Camp Registration and Scholarship Application
Kalimah Programs' 2017 Arabic Immersion Summer Camp (July 10 to Aug. 4) in Montgomery County, Maryland.

Please fill out a separate form for each child.

Email address
Child's First Name
Your answer
Child's Last Name
Your answer
Child's age
Child's grade in 2017-18
Your answer
Child's school name and location in 2017-18
Your answer
Parent/Guardian's First Name
Your answer
Parent/Guardian's Last Name
Your answer
Parent/Guardian's Phone Number
Your answer
Parent/Guardian's Email Address
Your answer
Primary Residence Address
Your answer
Primary Residence County
Second Parent/Guardian's First Name
Your answer
Second Parent/Guardian's Last Name
Your answer
Second Parent/Guardian's Phone Number
Your answer
Second Parent/Guardian's Email Address
Your answer
Home or Alternate Phone Number
Your answer
Emergency Contact (Full name, relationship, and phone number)
Your answer
Are you able to commit to bringing your child to the program and picking her/him up on time every week day for the entire four weeks (July 10 - August 4) of the program?
Which other program(s) has your child participated in or would be interested in registering for? (please specify day(s) and location(s))
Required
Child's prior knowledge of Arabic
Required
Are you applying for a merit-based or need-based scholarship to cover part or all of the program tuition? (please see instructions and requirements below)
(Deadline: April 7, 2017; scholarships cannot be combined; scholarship amount will be decided by Kalimah Programs' Staff by May 5; see requirements for each type before applying; all requirements must be submitted in one email message to info@ArabicKalimah.com with the name of the child applying for the scholarship clearly stated in the subject line)
Allergies & Special Needs (any food or other allergies or special needs we should be aware of?)
Your answer
How did you hear about Kalimah?
Do you have any questions, comments, and/or suggestions?
Your answer
By submitting this form, the parent/guardian of the named child above agrees to the following terms: (1) I give consent to allow Kalimah to take pictures of my child during the program to use in promotional materials, news, and updates; (2) full payment of program tuition and fees as advertised in the program flyer must be received by Kalimah Programs at least 30 days before the start date of the program using https://squareup.com/store/kalimah/ ; delay in remitting payment may result in cancellation of this registration and the spot may become available to other registrants; (3) no refund will be issued if cancellation is requested less than 20 days prior to the start date of the program; (4) classes may be cancelled or rescheduled at the discretion of the program director; every effort will be made to give ample notice to parents; (5) Kalimah is not responsible for any harm or injury that may result from above child's participation in named program or any activities under supervision of any Kalimah Programs' personnel, affiliates, or volunteers. (Please sign below with your full name and date)
Full name and date
Your answer
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms