ISPC Summer School Application Form

Please fill out the form below.

First Name: *

Last Name: *

Date Of Birth: *

Age: *

Gender: *

Fathers Name: *

Cell Phone: *

Fathers Email: *

Work Phone:

Mothers Name: *

Cell Phone: *

Home Phone:

Mothers Email: *

Address: *

City: *

Zip Code: *

Emergency Contact:

Name of Emergency Contact:

Emergency Contact Cell Phone: *

Address: *

City: *

Zip Code: *

Emergency Contact email:

Relationship: *

Food Allergies?:

Other Allergies including Medical Allregies?:

Other Information Essential for The School to Attend to the Student's needs:

I give permission to take picture of my child for class projects and/or masjid website: *

Yes

I authorize sunday school teachers/administrators/safety officers at Masjid Ebad Al Rahman to seek any and all emergency health : *

Yes

I am also willing to support the school either by committing time or financial support: *

Yes

I commit to dropping my child off and pick up from the school on time in Shaa Allah: *

Yes

I agree to terms and conditions of ISPC School: *

Agree

Islamic Society of Pinellas County