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info@ihsan.ca
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Home
About Us
Who We Are
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Islam Comprehensive
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Spring Youth Program Registration
Taha
2019-02-27T14:19:13-08:00
Please fill out the form below to register your child(ren) in the Al-Ihsan Spring Youth Program
Email
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
*
1
2
3
4
5
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
*
Male
Female
1 Health Card Number
*
1 Medical Conditions/Allergy Information
*
2- Child Two Full Name
Child 2: Date of Birth
2- Gender
Male
Female
2 Health Card Number
2- Medical Conditions/Allergy Information
3- Child Three Full Name
Child 3: Date of Birth
3- Gender
Male
Female
3 Health Card Number
3- Medical Conditions/Allergy Information
4- Child Four Full Name
Child 4: Date of Birth
4- Gender
Male
Female
4 Health Card Number
4 Medical Conditions/Allergy Information
5- Child Five Full Name
Child 5: Date of Birth
5- Gender
Male
Female
5 Health Card Number
5 Medical Conditions/Allergy Information
How do you plan to pay the fees for this program?
*
Etrasnfer
Credit Card
PayPal
Cash
Cheque
You will not be charged anything at this time. We will contact you with more information on how to proceed.
