Aisha Summer Camp Registration

Section 1: Student Information

Student’s Legal Last Name

Student’s Legal first Name

Gender
MaleFemale

Date of Birth

Age

Street Address and Unit/Apartment/Suite

CITY

ZIP CODE

Language spoken at home

Arabic Reading Level
NoneIntermediateFluent

How many Surahs memorized
1-1011-2021-30Other

Section 2: Family Information

Father Name

Street Address (if different from student) Unit/Apartment/Suite

CITY

Zip code

Phone number

Your email

Mother Name

Street Address (if different from student) Unit/Apartment/Suite

City

Zip code

Phone number

Your email

Section 3: PICK UP POLICY AND AUTHORIZATION FORM

I Give my permission to the following people to pick up my child/children from Aisha Center.

Name

Phone number

Relationship

Does your child have medical problems or allergies (food, medicine, etc.)
YesNo

Please list

Your message (optional)

Consent & Liability Release:
A-I hereby consent to use all of the Aisha Cultural Center Sport facilities and playground equipment’s and to play at the facility located at Aisha Cultural Center 1311 Hancock Lone Palm Rd Orlando, FL 32828. I understand and acknowledge that the use of outdoor facilities including the sport facilities involves risks including possible risk of injury to myself. I am choosing to use the facilities at my own risk. I assume full responsibility for all risks that may arise from my playing at the facility located at Aisha Cultural Center

B-I hereby release, waive, discharge, and hold harmless Aisha Cultural Center and its representatives and employees from any claims, suits, liabilities, judgments, costs and expenses for any property damage, loss or theft, personal injury, illness or other loss arising from the use of the sport facilities located at Aisha Cultural Center. This acknowledgment of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent

Parent/Guardian Signature

Please prove you are human by selecting the house.