Ramadan Child Care

First Child Name First Child Name * First Last
First Child Age *
Must be a number between 3 and 5
Second Child Name Second Child Name First Last
Second Child Age
Must be a number between 3 and 5
Third Child Name Third Child Name First Last
Third Child Age
Must be a number between 3 and 5
Please list any allergies for the children registering
Parent/Guardian Information
Parent/Guardian Name Parent/Guardian Name * First Last
Phone Number Phone Number * - ### - ### ####
Email Address *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Information
Emergency Contact Name Emergency Contact Name * First Last
Emergency Contact Relationship *
Emergency Contact Phone Number Emergency Contact Phone Number * - ### - ### ####
Waiver
Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement Notice:

This is a legally binding agreement. I understand that by signing this Childcare Waiver of Liability, I release and hold harmless the Islamic Society of Baltimore, and its owners, directors, officers, advisers, employees, agents, instructors, volunteers, childcare workers, and all other persons or entities acting for them from any and all claims, demands, suits, cost and charges, in connection with or arising out of the Islamic Society of Baltimore's childcare service, including but not limited to, personal injury, bodily harm, injury, or property damage occurring while the above child/children is/are in their care at the Islamic Society of Baltimore. I understand that if my child should become inconsolable during prayer, I am responsible to leave prayer and attend to my child. I will be responsible to feed my child and have my child use the restroom prior to start of class time to the best of my abilities. I understand I must remain in the Islamic Society of Baltimore at all times. I have read and understand the Islamic Society of Baltimore's Childcare Policy *

Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement Notice:

This is a legally binding agreement. I understand that by signing this Childcare Waiver of Liability, I release and hold harmless the Islamic Society of Baltimore, and its owners, directors, officers, advisers, employees, agents, instructors, volunteers, childcare workers, and all other persons or entities acting for them from any and all claims, demands, suits, cost and charges, in connection with or arising out of the Islamic Society of Baltimore's childcare service, including but not limited to, personal injury, bodily harm, injury, or property damage occurring while the above child/children is/are in their care at the Islamic Society of Baltimore. I understand that if my child should become inconsolable during prayer, I am responsible to leave prayer and attend to my child. I will be responsible to feed my child and have my child use the restroom prior to start of class time to the best of my abilities. I understand I must remain in the Islamic Society of Baltimore at all times. I have read and understand the Islamic Society of Baltimore's Childcare Policy Check the box to agree to the terms above.
How much would you like to donate towards the childcare program? (Suggested amount is $10/child) $ Dollars . Cents

Ramadan Child Care

Parent/Guardian Information

Emergency Contact Information

Waiver