Parent information

Parent Email Address ***Valid email address required***:

Parent Full Name:

Parent Phone #:

Emergency contact information

Emergency ContactName:

Emergency Contact Phone #:

Photography Consent

Photography Consent: --Please Select-- Yes No

Child(ren) Information

• Fee will be auto calculated based on your children information:
• Click "Add new child" button below to add your child(ren)
• Child Full Name, age and Allergy information

Total Amount($):

Add new child

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CHAGRIN VALLEY ISLAMIC CENTER - Add/Update Latest Update Section

Child Name	Child Age
Id:
Child Full Name:
Date of birth:
Allergies:
Has your kid attended the class last year?:	-- Please select -- Yes No
	Submit

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