ICGT Summer Camp Learn, grow, play, and have fun this summer! Complete the registration form below. Session 4: July 21 – July 31 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?* Member Non-Member Are 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*12345Select Camp Sessions* Session 4: July 21 to July 31 Session 3: July 7 to July 17 Student 1* First Last Student 1 Birthdate* Student 1 Grade*Student 2* First Last Student 2 Birthdate* Student 2 Grade*Student 3* First Last Student 3 Birthdate* Student 3 Grade*Student 4* First Last Student 4 Birthdate* Student 4 Grade*Student 5* First Last Student 5 Birthdate* Student 5 Grade*Consent I grant permission to have my child/children photographed/videotaped.PaymentCamps Price: $0.00 Single Week Exception Code*II_Single Week Exception Code*Single Week Exception Price: $0.00 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
