Please fill out the form below to register your child(ren) for Al-Ihsan’s 2020 Summer Youth Program.

Name

Parent/Guardian Full Name *

Primary contact person

Parent/Guardian Phone Number *

Parent/Guardian Email *

Home Address *

Home Phone

If applicable

City, Province *

Number of Students

One Two Three Four Five

If you are registering more than 5 children, please fill out the form a second time. Please fill out the sections below which apply (according to the number of children)

1- Student One Full Name *

Student 1: Date of Birth *

1- Gender *

1 Health Card Number *

1 Medical Conditions/Allergy Information *