Campislam Registration 2017-18 CampIslam Register your children at CampIslam Youth Halaqa. Every child separately. Mississauga Stephen Lewis Campus*CAMPISLAM SENIOR @11amCAMPISLAM JUNIOR @1:30pmPlease indicate academic semester*FIRST SEMESTER Sept 2017 - Dec 2017SECOND SEMESTER Jan 2018 - April 2018Student Name* First Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student Email* Enter Email Confirm Email Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent Full Name* Full Name Parent Cell Phone*Parent Email* Enter Email Confirm Email Emergency Contact Full Name* Full Name Emergency Cell Phone*We need at least 2 phone numbers on our database.Description of Allergies (if non, type 'non')*Next Steps*Please do not expect a confirmation email. Your confirmation is to show up 15minutes before Halaqa to submit payment of $130, per child per semester. Payment is by cheque payable to The Islamic Cultural Centre of Toronto. One cheque per family. Once paid, your information will be transferred to our email list. Within one week, we will email you requirements and surveys. Our email is JWP@ICCTCANADA.COM. Please always search your junk/spam folders.Terms & Agreement*I hereby agree that I will not hold the staff, leadership or volunteers of PDSB, YRDSB, ICCT and JWP liable in case of accident, injury and loss or damage of property in connection to the registration of my child/ren at CampIslam program including trips and activities. This includes any incidents which may occur during, on the way to, or on the way from the above stated event or premises. In addition, if I cannot be personally contacted, I give the bearer of this document my permission to authorize any emergency medical care that may appear necessary. CampIslam halaqa requires completion of frequent assignments. First session is a free trial. CampIslam fees are non-refundable.