Sunday School Registration | Islamic Education Center of PA

IECPA
Islamic Education Center of Pennsylvania

Islamic Sunda School

1109 West Linden Street Allentown PA 18102 Phone (610) 340-0095

School Registration Form 2016/2017, 1437/1438

Please fill in your Child/ Children information

Last Name *:	Father Name *:	Mother Name *:
Home Address* :

Home Phone# *:

Cell Phone# *:

Cell Phone 2#:

Email Address *:

Emergency Contact*:

Relationship to Child *:

Emergency Contact Phone Number*:

I, , do not hold the IECPA Sunday school staff and volunteers responsible for any harm or injury to my son/ daughter during the time they are on the premises of the Islamic Education Center, located at 1109 West Linden Street, Allentown, PA 18102. I will be fully responsible for any and all damages and/or vandalism that are caused to the building, classrooms, supplies or equipment used by staff that would have been caused by any negligence or abuse by my children. My child (or Children) and, myself will further comply with the rules and regulations set by the Sunday Islamic School of IECPA.

I here, by allow the Staff and/or Volunteers of the Islamic Sunday School of the IECPA in the case of an emergency to one or more of my children to administer CPR, First aid and/or contact Emergency personnel or to take my child to an Emergency room in which case I will be fully responsible for the costs of the given treatments and/or emergency care fees.

Known Behavioral or Moral Medical Issues:

School Registration Dues are $200 per child for the school year, with a family max of $600.
If a payment schedule is needed, the balance due can be divided into 3 equal installments. Dates of the installments are inputted in the boxes across.

For School Staff use only
Total Dues
Amount Paid		Date Paid
Balance
Payment Schedule	1st Installment	2nd Installment	3rd Installment
Payment Schedule

Parent/ Guardian Signature:

Date Signed:

Staff Member Helping: