Spring Youth Program Registration

Please fill out the form below to register your child(ren) in the Al-Ihsan Spring Youth Program

Parent/Guardian Full Name

Primary contact person

Parent/Guardian Phone Number

Parent/Guardian Email

Home Address

Home Phone

If applicable

City, Province

Emergency Contact Full Name

Must be different from the above name provided

Emergency Contact Phone 1

Emergency Contact Phone 2

Please provide a second number in case the first can not be reached

Relation to child(ren)

How many children are you registering

If you are registering more than 5 children, please fill out the form a second time. Please fill out the sections below according to the number of children and leave the reaminder blank.

1- Child One Full Name

Child 1: Date of Birth

1- Gender

1 Health Card Number

1 Medical Conditions/Allergy Information

2- Child Two Full Name

Child 2: Date of Birth

2- Gender

2 Health Card Number

2- Medical Conditions/Allergy Information

3- Child Three Full Name

Child 3: Date of Birth

3- Gender

3 Health Card Number

3- Medical Conditions/Allergy Information

4- Child Four Full Name

Child 4: Date of Birth

4- Gender

4 Health Card Number

4 Medical Conditions/Allergy Information

5- Child Five Full Name

Child 5: Date of Birth

5- Gender

5 Health Card Number

5 Medical Conditions/Allergy Information

How do you plan to pay the fees for this program?

You will not be charged anything at this time. We will contact you with more information on how to proceed.

Please fill out the form below to register your child(ren) in the Al-Ihsan Spring Youth Program

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