Childcare Registration - Al-Ihsan Educational Foundation

Al-Ihsan Childcare Registration

Step 1 of 3

Please select a program to register for Child Care(Required)

PARENT/GUARDIAN INFORMATION

Name(Required)

First Middle Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Please enter an email that is checked regularly. All pertinent information about the child care will be sent to this email.

Address(Required)

Street Address Address Line 2 City of Residence State / Province / Region ZIP / Postal Code

Select the Number of Children for whom you Require Child Care(Required)

Child 1 of 1(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 1 Allergies/Medical Contitions(Required)

Child Care Cost for Child 1(Required)

Price:

Child 1 of 2(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 1 Allergies/Medical Contitions(Required)

Child Care Cost for Child 1(Required)

Price:

Child 1 of 3(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 1 Allergies/Medical Contitions(Required)

Child Care Cost for Child 1(Required)

Price:

Child 2 of 2(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 2 Allergies/Medical Contitions(Required)

Child Care Cost for Child 2(Required)

Price:

Child 2 of 3(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 2 Allergies/Medical Contitions(Required)

Child Care Cost for Child 2(Required)

Price:

Child 3 of 3(Required)

First Name Middle Name Last Name

Date of Birth(Required)

Health Care Card Number(Required)

We require the health card number in case of emergencies where the parents cannot be reached.

Child 3 Allergies/Medical Contitions(Required)

Child Care Cost for Child 3(Required)

Price:

Consent(Required)

I have read and understood the above and allow my child(ren) (those listed above in this form) to take part in the indoor and outdoor activities at Al-Ihsan

By signing this form, I affirm that I understand that these indoor and outdoor activities may expose myself and/or my child(ren) to some risks and I assume any such risk or injury that may arise therefrom. I accept full responsibility for all medical expenses for any injuries that might occur to my child by reason of his/her participation. By signing this form, I hereby release Al-lhsan, it’s Board members, administrators, directors, officers, teachers, employees, agents, assigns, and volunteers from and against any and all claims, demands, actions, complaints, suits or other forms of liability that any of them may sustain (a) arising out of my child’s failure to comply with local, state, and federal laws and school policies, procedures, and Rules of Conduct; (b) arising out of any damage or injury caused by or to my child during any of these activities or while travelling by foot to and from the designated playgrounds and facilities; or (c) arising out of a parent/guardian/or other designated driver’s operation of a motor vehicle or school bus in relation to this activity. I also agree to indemnify and hold harmless the released parties from the released claims, including any and all related costs, attorney fees, liabilities, settlements, and/or judgments.
During Al-Ihsan's programs and activities, attendees and/or children are occasionally photographed to share their progress and activities with their parents and occasionally post on social media. Please read the media consent below and choose one of the options that follow.
I hereby grant Al-Ihsan Educational Foundation (“Al-Ihsan”), and its agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of myself and/or My Child, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any Al-Ihsan publication or on the Al-Ihsan social media/ websites, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein my or My Child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless Al-Ihsan and its agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of my or My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
THIS IS A RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING

Signature(Required)

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Total

Coupon Code

Credit Card(Required)

Card Details

Cardholder Name

Al-Ihsan Childcare Registration

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