Akron Masjid (Saturday School 2024-2025)

Akron Masjid (Saturday School 2024-2025)

Minimum Age 5, and maximum Age 17 years old. First Day of School Sep 28th, 2024
Registration and lunch fees are $100 per child and are due on the day of registration. Tuition fee is $300 for each child for the whole year.
Child's Name*

First NameLast Name
Date Of Birth*

MonthDayYear

2nd Child info
Name

FIRST NAMECHILDS LAST NAME
DATE OF BIRTH

MonthDayYear

3rd Child's Info
Name

FIRST NAMECHILDS LAST NAME
Date of Birth

MonthDayYear
Date

4th Child's Info
Name

FIRST NAMECHILDS LAST NAME
DATE OF BIRTH

MonthDayYear
Date

5th Child's Info
Name

FIRST NAMECHILDS LAST NAME
DATE OF BIRTH

MonthDayYear
Date

6th Child's Info
Name

FIRST NAMECHILDS LAST NAME
DATE OF BIRTH

MonthDayYear
Date

Child's Address
Address

STREET ADDRESS

Street Address Line 2

TOWNCITYSTATE

ZIP

Parent / Guardian Info
NAME of PARENT / GUARDIAN*
CELL PHONE*
HOME PHONE
PARENTS PLACE OF EMPLOYMENT / SCHOOL
WORK PHONE
EMAIL ADDRESS
example@example.com
WORK EMAIL
example@example.com
Emergency Contact Name*
Relationship
Address (Daytime)
Phone Number*
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.

2nd Emergency Contact
2nd Emergency Contact Name
Relationship
Address (Daytime)
Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.

Other Responsible Person
3rd Emergency Contact Name
Other Responsible Person
Address (Daytime)
Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.

Doctor
Doctor Name
Address (Daytime)
Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.

SPECIAL INFORMATION ABOUT CHILD (DIET, ALLERGIES, HABITS, FEARS, INTERESTS, ETC.)

Registration and lunch fees are $100 per child and are due on the day of registration.

Tuition fee is $300 for each child for the whole year,

Please select a Payment Plan

One installment (total $400)

Three installments (total $400)

Payment Due	Payment Amount Per Child
September 21, 2024	$200
November 2, 2024	$150
February 1, 2024	$50

The program starts on Sat September 21st from 10:00 AM- 2:00 PM.

Student Placement test will be held on Sat September 21st from 10:00 am to 2:00 PM.

Students will be dismissed at 2:00pm. $20.00 late fee will be charged after 2:15pm for each 10 minute late.

AGREEMENT:

I consent to the enrollment of the child listed above in the Akron Masjid and have been advised of the policies regarding fees, transportation and the services provided by Akron Masjid. I agree that in case of an accident or injury, emergency medical care may be given in the event that I or the person(s) designated above cannot be reached.

SIGNATURE PARENT OR PERSONS LEGALLY RESPONSIBLE

Clear
Tuition and Registration Fees
Board Member Signature (Leave this blank for Akron Masjid)

Clear

Akron Masjid (Picture Consent Form)
I give Akron Masjid permission for the following pictures to be taken of my child:

PicturesVideoPictures for the NewspaperT.V/Internet
First Childs Name
Second Childs Name
Third Childs Name
Fourth Childs Name
Fifth Childs Name
Sixth Childs Name
Signature

Clear
If you do not want any of the above, please sign below. I choose not to have any pictures taken of my child.
Signature

Clear

Release of Liability

1147 S. Old Main St, Akron, OH 44301 Tel: (330) 374-9799
I agree for myself and the members of my family that, in exchange of participation in the activity of the Saturday School of Akron Masjid to the following:
- I agree to obey and observe any and all posted warnings and rules, and agree to follow any and all directions and oral instructions, given by the Saturday School teachers, or representatives, or employees or agents.
- Iunderstand that my, and my family members' time at the facility may include various activities that may be hazardous to myself and my family members. I hereby expressly and specifically assume the risk of injury or harm in these activities and release the Saturday School from any and all liability for injury, illness, loss, death, or property damage resulting from the activities of my, and my family's use of or presence upon the facilities, whether caused by the fault of myself, my family members, or other third party.
- I agree to identify and hold harmless to Saturday School, its affiliates, its respective officers, directors, teachers, agents, and employees from any and all claims, demands, losses, causes of action, lawsuits, judgments, including attorneys' fees and costs, arising out of my and my family members' use of or presence upon the facility of Saturday School.
- In the event of damages, I agree to pay for any and all damages that may be caused by me or my family's negligent, reckless, or willful actions.
- Any equitable or legal claim, or claims that may arise from the participation in the Saturday School, shall be resolved under the laws of the state of Ohio.
I HAVE READ THAT DOCUMENT AND I UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
The name of the legal guardian on behalf of the minor
Relationship
Signature of the legal Guardian on behalf of the minor

Clear
Should be Empty:

Akron Masjid (Saturday School 2024-2025)

Registration and lunch fees are $100 per child and are due on the day of registration. Tuition fee is $300 for each child for the whole year.

Parent / Guardian Info

Akron Masjid (Picture Consent Form)

Release of Liability