Summer Camp Registation

ISLAMIC COMMUNITY SCHOOL
Summer Camp Application Form

STUDENT INFORMATION

* Indicates required field

STUDENT NAME *

First

Last

AGE OF STUDENT #1 *

BIRTH DATE OF STUDENT #1 *

GENDER of STUDENT #1 *

MALE FEMALE

STUDENT NAME #2 *

First

Last

AGE OF STUDENT #2 *

BIRTH DATE OF STUDENT #2 *

GENDER OF STUDENT #2 *

MALE FEMALE

STUDENT NAME #3 *

First

Last

AGE OF STUDENT #3 *

BIRTH DATE OF STUDENT #3 *

GENDER OF STUDENT #3 *

MALE FEMALE

ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

Please list any allergies, dietary restrictions, or medical conditions: *

HOME PHONE *

Languages Spoken at Home *

Name of any other school/program student attended: *

PARENT INFORMATION

Father's Name *

First

Last

Profession *

Address (if different from above) *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Cell Number *

Mother's Name *

First

Last

Profession *

Address (if different from above) *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Cell Number *

EMERGENCY CONTACT INFORMATION

RELATIONSHIP TO STUDENT *

CELL PHONE *

NAME OF EMERGENCY CONTACT *

First

Last

WORK PHONE *

Submit

Payment can be made with a check payable to: Manassas Mosque OR via Venmo
@Manassas-Mosque, comment "summer camp".

PLEASE ALSO DOWNLOAD, PRINT, AND BRING WITH YOU THE FOLLOWING 3 FORMS AT THE TIME OF DROP OFF

2024_ics_summer_camp_disclosure_form.pdf
File Size:	55 kb
File Type:	pdf

Download File

2024_ics_summer_camp_liability_form.pdf
File Size:	57 kb
File Type:	pdf

Download File

2024_ics_summer_camp_tuition_contract.pdf
File Size:	75 kb
File Type:	pdf

Download File

​ISLAMIC COMMUNITY SCHOOLSummer Camp Application Form​​

STUDENT INFORMATION

PARENT INFORMATION

EMERGENCY CONTACT INFORMATION

Stay Updated

ISLAMIC COMMUNITY SCHOOL
Summer Camp Application Form