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Children Information:

 
1st Child Name
1st Child Date Of Birth
2nd Child Name
2nd Child Date Of Birth
3rd Child Name
3rd Child Date Of Birth
4th Child Name
4th Child Date Of Birth
 

Parents Information

 
 

Emergency Contacts (up to three names)

 
 

Medical Information


 


Acknowledgment and signature:

Refund policy: 100% of the tuition may be refunded during the first week of school.  50% of the tuition may be refunded during the second week.  After the second week of school, there will be zero refund issued regardless of the circumstances.

Medical Emergency policy:It is the child care provider's policy to notify a parent when a child is ill or in need of medical attention. Occasionally we are unable to contact parents, and we need to get immediate help for the child. Our procedure is to have the child taken to the nearest emergency service by ambulance. (Ambulance fee is the parent's responsibility.) If an ambulance is not available, the child care provider/staff of the child care will transport the child I hereby give permission to the child care provider/staff to make necessary transportation.

Yes I want to enroll my child in the ICM Weekend school program and I have read and understood the terms, policies, rules and regulations on this application, ICM, and the weekend school program.

I understand that the ICM (which refers to the Islamic Center of Murfreesboro) is a non-profit organization. We also understand that all of the ICM activities and services are not for profit services, managed jointly by paid and volunteer individuals. We further understand that one of the main conditions of admissions, volunteering and/or participation in any activity or service offered by the ICM or its committees or affiliates, including but not limited to the weekend school and classes, is that the total liability of the ICM and all its committees, affiliates, paid staff and volunteers, regardless of the circumstances and/or the issues, is limited to an amount not to exceed $1000. We accept this condition, without any reservation.

By filling your name below and submitting this form you acknowledge that you have read and accepted the above statements and the terms of service and rules.

Tuition Due: Tuition per semester is $100 per 1st child excluding books. Please make checks payable to ICM  Tuition is $75 for second child, $50 for third child and free for fourth child and above.

 

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