ICM Sunday School Registration Form for the year25/26

ICM Sunday School Registration Form

Please fill out the form for registration for the school year of 25/26
Please go to www.icmny.org/2025fundraiser
How Many child(ren)Will Enroll in Sunday School*

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Academic School Year blanks* .
Gender*

MF
Name of Previous Islamic School*

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Academic School Year blanks* .
Gender*

MF
Name of Previous Islamic School*

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Academic School Year blanks* .
Gender*

MF
Name of Previous Islamic School*

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Academic School Year blanks* .
Gender*

MF
Name of Previous Islamic School*

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Academic School Year blanks* .
Gender*

MF
Name of Previous Islamic School*

Guardian#1 Name*

First NameLast Name
Occupation*
Phone Number
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian#2 Name

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Person(s) (other than parents) authorized to pick up child(ren) from school.
Name blanks Phone Number Relationship blank
Name blanks Phone Number Relationship blank
Name blanks Phone Number Relationship blank
AUTHORIZTION FOR EMERGENCY MEDICAL TREATMENT
In case of emergency involving my child(ren) and when I can not be reached, I hereby authorize the Islamic Center Of Melville/ Weekend School or designate to see and authorize the examination and medical treatment of child(ren), by appropriate medical professionals and facilities.
Name of Physician/Pediatrician*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Any Allergies or Medical Conditions?*

YesNo
Please give details
I, undersigned, agree with the following statements:*

I am the parent/guardian of the child indicated above.If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatmentICM reserves the right to capture photographs and videos of students/campers during activities and may use these images for internal and external communication, including the school website, publications, and promotional materials. Parents or guardians have the right to opt-out of having their child's image used. If you wish to opt out, please contact administration.
All students enrolled in ICM School must meet the following requirements:
1. Enrolled in public school or state certified private school.
2. Free of any communicable disease
3. Fully immunized and have an up to date immunization record.
Signature
Date

MonthDayYear
Date
Registration Fees

Registration Fees (5+ children please call the office 631-249-3298)*

prevnext( X )

USD

Payment Methods

Credit Card

Apple Pay

After submitting the form, you will be redirected to Apple Pay to complete the payment.

Google Pay

After submitting the form, you will be redirected to Google Pay to complete the payment.

Cash App Pay

After submitting the form, you will be redirected to Cash App Pay to complete the payment.

ACH Bank Transfer

Afterpay

After submitting the form, you will be redirected to Afterpay to complete the payment.

5+ childeren please call the office 631-249-3298
Should be Empty:

ICM Sunday School Registration Form

Person(s) (other than parents) authorized to pick up child(ren) from school.

AUTHORIZTION FOR EMERGENCY MEDICAL TREATMENT

Payment Methods