2024 - 2025 ICR Sunday School Registration

ICR Sunday School Registration Form for the 2024 - 2025 school year. Please contact ICR Sunday School Staff at school@icrmuslim.org with any questions.

Family Contact Information

Parent 1 Name

*

Parent 1 Gender

*

Please select one option.

Male Female

Parent 1 Email

*

This address will receive a confirmation email

Parent 1 Cell Phone

*

Parent 2 Name

Parent 2 Gender

Please select one option.

Male Female

Parent 2 Email

This address will receive a confirmation email

Parent 2 Cell Phone

Family Mailing Address

*

Family Home Phone

Did your child(ren) attend ICR Sunday School last year?

*

Please select one option.

Yes No

Student 1 Information

Student Name

*

Gender

*

Please select one option.

Male Female

Date of Birth

*

Last Grade Completed at ICR (or New Student)

*

Allergies

Student 2 Information (If applicable)

Student Name

Gender

Please select one option.

Male Female

Date of Birth

Last Grade Completed at ICR (or New Student)

Allergies

Student 3 Information (If applicable)

Student Name

Gender

Please select one option.

Male Female

Date of Birth

Last Grade Completed at ICR (or New Student)

Allergies

Student 4 Information (If applicable)

Student Name

Gender

Please select one option.

Male Female

Date of Birth

Last Grade Completed at ICR (or New Student)

Allergies

Student 5 Information (If applicable)

Student Name

Gender

Please select one option.

Male Female

Date of Birth

Last Grade Completed at ICR (or New Student)

Allergies

Emergency Information

Emergency Contact Name (Someone other than parent)

*

Emergency Contact Relationship

*

Emergency Contact Phone Number

*

Special instructions or notes for ICR staff about your child(ren)

Liability Release and Medical Treatment Permission

The undersigned does hereby give permission for Student(s) named above to attend and participate in the Islamic Center of Rockland ("ICR") Sunday School during the period of September 1, 2024 – August 31, 2025.

LIABILITY RELEASE: In consideration of ICR allowing the Student(s) to attend Sunday School, I, the undersigned, do hereby release, forever discharge and agree to hold harmless ICR, its directors, employees, volunteers and teachers (collectively herein the “Mosque”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Student(s) while involved in any Sunday School related activity. I, on behalf of my minor Student(s), hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in the Sunday School. The undersigned further hereby agrees to hold harmless and indemnify said Mosque for any liability sustained by said Mosque as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any medical professional licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

Electronic Signature*

*

*By entering my name in the box above, I confirm I have read and agree to the Liability Release and Medical Treatment Permission above.

Code of Conduct

The safety of our kids is our number one responsibility. Maintaining the integrity of the education is dependent upon the cooperation of everyone in the educational community – students, teachers, parents, administrators and the non-teaching staff. Parents are strongly urged to recognize that the education of their child(ren) is a joint responsibility of the parents and the school.

1. Parents are not allowed downstairs after assembly (Kindergarten parents may remain downstairs).
2. Parents are not permitted to discipline another child that is not their own.
3. Bullying is prohibited at all times while at ICR.
4. Shouting and aggressive behavior is not permitted.
5. All issues during Sunday School should be raised to teachers and administration (principal and assistant-principal).
6. Kindergarten parents are required to remain at ICR during Sunday School.
7. Harassment of any kind, including based on a person’s race, color, ethnicity, disability, physical appearance, national origin, gender, sexual orientation or any other category, is prohibited.
8. Consequences for infraction of rules by either students or parents will result first in a warning, followed by removal from Sunday School for subsequent infraction.

Electronic Signature*

*

*By entering my name in the box above, I confirm I have read and agree to the Code of Conduct above.

Donation to ICR

- $400 for 1 Child
- $700 for 2 Children
- $900 for 3 Or More Children

If you would prefer a monthly payment plan, please send a separate email to: school@icrmuslim.org.

Payment

1 Child ($400) 2 Children ($700) 3+ Children ($900)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

ICR Sunday School Registration Form for the 2024 - 2025 school year. Please contact ICR Sunday School Staff at school@icrmuslim.org with any questions.

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