Kids Summer Camp Registration Form

Please enable JavaScript in your browser to complete this form.
Selected Value: 1

Student Information

Student First and Last Name
Date of Birth

Parent / Guardian Information

Parent/Guardian 1 First and Last Name
Parent/Guardian 2 First and Last Name

Emergency Contact Information

Name of Local friend or relative (not living at same address)

Consent & Agreements

Emergency Consent
I hereby authorize ISA to provide any information on this form to the supervising teacher or staff in order for them to care for my kid during school hours in the event that an injury requires medical attention. I am aware that every effort will be made to get in touch with me, but in the event that a medical emergency necessitates immediate attention and I am unable to be reached, I authorize ISA to provide my kid with the appropriate medical care, including authorization to transport him or her to the closest medical institution.

Liability Consent
I am aware of and accept the fact that, despite taking all reasonable measures to ensure student safety, the Islamic Society of Ajax staff cannot be held responsible by me in the event that my child suffers a personal injury or accident while attending school at any time during the school day on a school trip or during a school outing.

Fee: $140 per child

Confirmation and Submission

The above information is true to the best of my knowledge. I have read, agreed and understood all rules and terms of this form.