ICGT Summer Camp Learn, grow, play, and have fun this summer! Complete the registration form below. June 23 – July 3 Tuesday – Friday 10 am – 2 pm Summer Camp Registration Form Family InformationSingle Parent Household?* Yes No Select parent* Single Mother Single Father Father* First Last Father's Cell Phone*Father's Email* Mother* First Last Mother's Cell Phone*Mother's Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a member of ICGT?*YesNoAre you interested in becoming a member?* Yes No Would you like to volunteer with the Summer Camp?* Yes No Volunteer First Name*Do any children have food allergies?* Yes No Food Allergies*Enrollment InformationNumber of students enrolling*12345Student 1* First Last Student 1 Birthdate* MM slash DD slash YYYY Student 1 Grade*Student 2* First Last Student 2 Birthdate* MM slash DD slash YYYY Student 2 Grade*Student 3* First Last Student 3 Birthdate* MM slash DD slash YYYY Student 3 Grade*Student 4* First Last Student 4 Birthdate* MM slash DD slash YYYY Student 4 Grade*Student 5* First Last Student 5 Birthdate* MM slash DD slash YYYY Student 5 Grade*Consent I grant permission to have my child/children photographed/videotaped.PaymentMember*1 StudentMember*2 StudentsMember*3 StudentsMember*4 StudentsMember*5 StudentsNon-Member Price*1 StudentNon-Member Price*2 StudentsNon-Member Price*3 StudentsNon-Member Price*4 StudentsNon-Member Price*5 StudentsSingle Week Exception Price: $0.00 Financial Aid Code*Non-Member Financial Aid Amount Price: Member Financial Aid Amount Price: Donate to support a student or donate to the Summer Camp Enter numbers only, for example: 50Would you like to cover the payment transaction fee so all the money goes to the mosque?* Yes No Payment company fee Price: $0.00 Total $0.00 Credit Card*Card Details Cardholder Name
