ICEV 5 Weeks "Youth Summer Program" for Boys 11-17 yrs old Starts June 6th until July 7th. Every Monday, Tuesday, Wednesday, & Thursday (1:00 pm - 3:30 pm)

Address: Islamic Center of the East Valley @ 425 N Alma School Rd. Chandler, AZ 85224
For more info Text only : (480) 628-8971
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Email *
Youth First and last Name: *
Any Medical problems (allergies) you may have: *
Please select  youth gender: *
Youth Age: *
Contact Phone Number: *
Parents Acknowledgement *
We, the parents of the youth (under 18) listed on this form, who plan to participate in ICEV Summer Program which require the youth to stay from 1:00 pm until 3:30 pm at the facility hereby waive all claims against ICEV and its officers, directors, employees and, volunteers in case of any accidents, incidents or medical emergency during their stay. We also agree that we will assume full financial responsibility and pay for any damages to ICEV facility, gym facility, equipment, furniture etc. caused by our children. *
Parent Full Name as signature
A copy of your responses will be emailed to the address you provided.
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