Taraweeh Childcare

Taraweeh Childcare Program

Parent/Guardian Information

First Name

Last Name

Phone number

Children Information

First Name

Last Name

Date of Birth

Does your child have any allergies or medical conditions?

Yes

Please enter your child's allergies or medical conditions

Will you be enrolling a second child?

Yes

Second Child First Name

Second Child Last Name

Second Child Date of Birth

Does your Second child have any allergies or medical conditions?

Yes

Please enter your 2nd child's allergies or medical conditions

Will you be enrolling a third child?

Yes

Third First Name

Third Last Name

Third Date of Birth

Does your Third child have any allergies or medical conditions?

Yes

Please enter your Third child's allergies or medical conditions

Liability Disclaimer:

By enrolling my child in the Taraweeh Childcare Program, I acknowledge that The Indianapolis Muslim Community Association (IMCA) and its volunteers, staff, and affiliates are not responsible for any injuries, accidents, or medical conditions that may occur while my child is in their care. I understand that while every effort will be made to ensure a safe environment, I assume full responsibility for my child’s well-being and release IMCA from any liability. In case of an emergency, I authorize the childcare staff to seek necessary medical assistance for my child.

Additionally, I understand that if my child consistently misbehaves or disrupts the program, I may be asked to remove them from the childcare service.

I have read and agree to the Liability Disclaimer

Parent/Guardian Information

Children Information

Liability Disclaimer:

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