Juniors' programs registration form

Does the child have any medical problems which the school should be aware of? If yes, please explain.*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
In the event of injury or illness to my child, I hereby authorize Alnoor Islamic Center representative to secure whatever treatment is deemed.*

I acknowledge.
Which school is your Son/Daughter currently attending?*
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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Please submit a minimum payment of $6/Junior to reserve their spot.*

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Junior Iftar