ICO Itikaf Registration

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Disclaimer: Islamic Center of Orlando (ICO) shall not be held responsible for any injury, loss, expense or damage of any kind whatsoever suffered or incurred by any person who attends the Itikaf Program on our site located at 11543 Ruby Lake Road, Orlando, FL 32836. By signing below, you agree to adhere to ICO policies and procedures, and will not hold Islamic Center of Orlando and its entities liable for any suffering that may occur.

- State or Government issued picture ID is required. Please bring a copy at time of starting Itikaf
- This form, filled out to its entirety, with signature of participant

Email *

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Primary Phone *

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Signature (Type Full Name) *

Send me a copy of my responses.

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