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Summer Activities & Qur'ān Program
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Date of Birth (Month/Day/Year)
*
Your answer
Child Gender
*
Male
Female
Required
Address
*
Your answer
Will Child be attending on a full time or part time basis?
*
Part Time (9am -12pm Five days a week full 6 week program)
Full Time (9am-4pm Five days a week full 6 week program)
Other:
What weeks will your child attend?
*
June 10 - 14
June 17 - 21
June 24 - 28
July 8 - 12
July 15 - 19
July 22 - 26
Required
If marked other for above question, please specify weeks and full/part time:
*
Your answer
Medical Conditions or Allergies
Your answer
Does your child take any medications?
*
Yes
No
If yes, please list:
Your answer
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