Clone of 2025 IQRA Summer Program Registration

Emergency Contact Information
Primary Emergency | Contact Name

First NameLast Name
Primary Emergency | Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Emergency | What is your relationship with this person?
Secondary Emergency | Contact Name

First NameLast Name
Secondary Emergency | Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency | What is your relationship with this person?

Medical Information
Health Card Number
Allergies
Additional Medical Notes
Terms of Agreement
In the event of an emergency, if I cannot be reached, I authorize the calling of a doctor/Certified Emergency Personnel and the providing of necessary medical services in the event my child is injured or becomes ill. I understand that although the Weekend School will be staffed by mature and responsible adults who will do their best to ensure the well-being of my child/children, I shall not find the Iqra Summer Program, Abu Huraira, or their staff liable for any injury or loss of property.

Payment Information
(Tuition is $120 per child for 2 days a week and $240 per child for 4 days a week. The only payment option is a one-time direct bank withdrawal. There is a NSF charge for missed payments
Name of Account Holder

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Account Number
Institution Number
Transit Number

Photography & Media Release
I hereby give Abu Huraira Center consent to use and reproduce my child(ren)'s name/image for promotional, educational, and fundraising purposes related to Abu Huraira Center.
I understand and agree to the above statement.
Parent Signature
Date Signed

MonthDayYear
Date
Should be Empty:

IQRA Summer Program