Mohebban Ramadan Overnight Camp Registration
Fees can be paid via Zelle to "mohebbanzelle@gmail.com" or CHECK written to 'Mohebban/Islamic Education Center.' Be sure to include the name of the attendees in the payment description/notes section. 

Please email mohebbancoordinators@gmail.com if the payment is burdensome to your family.

Brothers ages 13-18
Date: 3/16
Fee: $20

Sisters ages 13-18
Date: 3/22
Fee: $

Brothers/Sisters ages 6-12
Date: 4/5
Fee: $25

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Child #1 First/Last Name *
Child #1 Group
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Child #2 First/Last Name
Child #2 Group
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Parent #1 Name
 *
Parent #1 Email
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Parent #1 Phone Number
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Non-parent Emergency Contact Name
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Non-parent Emergency Contact Phone Number
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Do any of your children have allergies, medical conditions, or special dietary needs?
If so, please list.
I consent to having my child's picture/video taken during the overnight camp.
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Required
I agree to indemnify, release and hold harmless the Muslim Community School, the Alim Academy, the Islamic Education Center, Mohebban-e-Fatemeh, and their respective officers, agents, employees and volunteers from any and all costs, liabilities, expenses, claims, compensation, demands, or causes of action on account of any loss or damage to person or property of the aforementioned child arising out of or in connection with his/her participation in the weekly programs.
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Required
I also give my permission to the leaders of this program to secure emergency medical or surgical treatment for my child if there is insufficient time to contact me, and to secure routine, non-surgical medical care as needed.
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Required
Payment Method:
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Electronic Signature
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