2020 Kalimah Summer Camp Application

Participant's Name*

First NameLast Name

Participant's Date of Birth*

FemaleMale

Participant's Grade in 2020-2021*

Participant's School*

Add city and state, if not an MCPS school

Parent's Name*

First NameLast Name

Email*

Confirmation Emailexample@example.com

Phone Number*

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Second Parent/Care Giver's Name

First NameLast Name

Second Parent/Care Giver's Email

Confirmation Emailexample@example.com

Second Parent/Care Giver's Phone Number

Format: (000) 000-0000.

Allergies, Special Needs, and/or Accommodation Requests*

Emergency Contact(s) (in case parent/care giver cannot be reached)*

1) Chef Scientists: Food & Nutrition (Ages: 11-14)2) Engineers: Builders Camp (Ages: 8-10)3) Entrepreneurs: Make & Trade at Souq (Ages: 5-7)

Due to the Covid-19 epidemic, we have made some changes to amounts and requirements of QFI-provided tuition scholarships. Please answer the following questions accurately in order to provide QFI accurate information about scholarship recepients.

Tuition scholarships cover 75-100% of the tuition based on availability of funds (please upload a copy of your 2018 or 2019 household income tax document showing net and gross income amounts or a copy of a document showing qualification for federal/state/county assistance. Scholarships will be dispersed on a first-come-first-serve basis to all applicants regardless of income level.)Payment plan (50% before camp starts and 50% before camp ends)None

Upload documents supporting scholarship application

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IMPORTANT FINANCIAL INFORMATION (Please read through before submitting the form)

A non-refundable processing fee of $15 is required for each application.

A $100 deposit is required at the time of registration, unless tuition is paid in full. This deposit is to guarantee and secure your child's spot and will be applied towards the child's materials and fees balance. The amount of materials fees will depend on the number of weeks of camp enrollment and is estimated to be $100 for the full three weeks.

Camp deposits are fully refundable if registration cancellation is requested in writing at least one week before camp starts. If cancellation is requested within the week before camp starts, the cost of materials for the first week will be deducted from the deposit and the remaining amount of the deposit may be refunded within two weeks after the end of camp. If cancellation is requested after camp has started, the full deposit is automatically forfeited.

Scholarship recipients must attend all 3 weeks of camp as per scholarship terms and conditions.

For alternative payment methods or assistance in paying camp deposit, contact us at info@KalimahPrograms.org

Payment Info*

Application Processing Fee (non-refundable)$15.00

Deposit$100.00

The deposit is to secure your child's spot in the camp; the amount of the deposit automatically applies towards camper's materials and fees balance. If tuition is paid in full with the application processing fee, no deposit is needed.

Tuition$250.00

Number of Weeks

Enter coupon

Total $0.00

Credit Card

Comments/Questions

Signature*

I UNDERSTAND THAT THERE ARE POTENTIAL DANGERS INVOLVED IN PARTICIPATION IN PROGRAM ACTIVITIES. I AM AWARE OF THE RISKS AND HAZARDS RELATED TO THESE ACTIVITIES. I UNDERSTAND THE RULES AND REGULATIONS FOR EACH ACTIVITY, AS EXPLAINED IN ANY WRITTEN OR EMAILED MATERIALS AND/OR EXPLAINED BY STAFF/VOLUNTEERS. I GIVE MY CHILD PERMISSION TO PARTICIPATE IN ALL KALIMAH ACITIVITES. I RELEASE, HOLD HARMLESS, AND INDEMNIFY KALIMAH AND ALL OF ITS STAFF, VOLUNTEERS, AND AFFILIATES FROM AND FOR ANY CLAIM, INJURY, OR OTHER LIABILITY OF ANY KIND WHICH IS CAUSED DIRECTLY BY PARTICIPANT, OR WHICH RESULTS FROM OR DURING MY CHILD'S PARTICIPATION IN THE PROGRAM. ON BEHALF OF THE CHILD/PARTICIPANT, I HEREBY CONSENT TO THE USE OF PHOTOGRAPHS, VIDEO FOOTAGE, AND CLASSWORK OF THE PARTICIPANT IN PUBLICATIONS, WEBSITE, AND OTHER MEDIA RELATED TO KALIMAH PROGRAMS.

Kalimah Programs' Summer Camps ِApplication Form

Credit Card