Al-Rahman Summer School Registration

Al-Rahman Summer School Registration

For Assistance in Filling up the Form Please contact :Br. Sherfudeen 770-851-5899
Parent Information
Father's Name

First NameLast Name
Father's E-mail
example@example.com
Father's Mobile Number
Format: (000) 000-0000.
Mother's Name

First NameLast Name
Mother's E-mail
example@example.com
Mother's Mobile Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Student Information
Number of Students
Total Tuition Fees
Course Dates : June 9th - July 9th
Tue, Wed, Thru : 11 am - 2:30 pm
*$200 per child and $150 for each additional sibling
Emergency Contact Information
Emergency Contact's Name

First NameLast Name
Emergency Contact's E-mail
example@example.com
Emergency Contact's Mobile Number
Format: (000) 000-0000.
I, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Masjid Al-Rahman / Cumming Community Center, its members, Board, Teachers, Administration, and any students for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, property damage or death that above student(s) may suffer as a result of their participation in the school, regardless of whether the injury, damage or death is caused by the negligence or fault of the releases.
Acknowledgement
My Charges

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