Summer Fun Registration Form 2024

We are excited to announce the ISBCC Summer Fun Program 2024 registration is now open!

Join us for a fun and enriching Summer Program with Daily Qur'aan, Prophet stories, STEAM Activities, Arts & Crafts & Workshops.
Dates: July 8th – August 8th
Ages: 4 - 12 Years
Days: Mon – Thu
Time: 9 AM - 2:00 PM
Location: ISBCC, 100 Malcolm X Blvd, Roxbury MA

Space is limited! Register early to guarantee a spot.

Payment Instructions:

Please note that the payment for each week, per child registered is $200. You may register your child(ren) for 1 week-5 weeks.

How many child(ren) are you registering? *

First Child's Name *

First

Last

First Child's Age *

Second Child's Name *

First

Last

Second Child's Age *

Third Child's Name *

First

Last

Third Child's Age *

Fourth Child's Name *

First

Last

Fourth Child's Age *

Address of Child(ren): *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Father/Guardian Name *

First

Last

Father/Guardian Email *

Father/Guardian Phone Number: *

Mother/Guardian Name *

First

Last

Mother/Guardian Email *

Mother/Guardian Phone Number *

Does your child have any allergies? *

Does your child have any medical needs? *

Does your child have any Special Needs? *

Yes
No

If yes, please specify *

Which languages are spoken in your household? *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Which week(s) will you be registering your child(res) for? Please note that the payment for each week registered per child is $200.

Payment Type:

One-time Payment
Weekly Payment

The first payment for the selected child(ren) will be charged immediately, and the payments for next week(s) will be scheduled accordingly.

Single Item

Total:

$ 0.00

Please confirm below: *

You grant permission to take your child on field trips and outings
You grant permission to take pictures of your child during camp activities
You grant permission for quailified staff to administrate first aid incase of emergencies
You grant permission for staff to apply sunscreen
For children under the age of 5: You grant permission for staff to assist your child with toileting needs, if needed.

Billing Name *

First

Last

Billing Email *

Billing Phone

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

By registering for this event, I hereby consent for the Islamic Society of Boston to take photos, or videos during the session with the possibility of the photo or video being displayed on its media communications channels (ie. social media, website, email, newsletter). This includes any recording, photos, or videos taken on remote learning platforms such as Zoom or Google Meet. Specifically, I grant permission for qualified staff to:

- take my child on field trips and outings,

- take pictures of my child during camp activities,

- apply sunscreen and administer first aid to my child in case of emergencies, and

- assist my child (if under the age of 5) with toileting needs, if needed.

I do this with full knowledge and consent and waive all claims for compensation for use or for damages.

ISB/CC waives all responsibilities of personal injury, damage to belongings or loss of property.

Checkboxes *

I agree to the above statement.