Please complete this form to register your son(s)/daughter(s) for Al-Rahmah 2009

Summer Camp. This form, shot records, and payment in full must be submitted for
each camper to be enrolled in Al-Rahmah Summer Camp. Please read all information
carefully. Incomplete forms will not be processed. Registration form and payment in
full must be received by June 27th 2009.

Mail forms to Al-Rahmah Summer Camp at:

6631 Johnnycake Rd
Baltimore, MD 21244

For questions, call Masjid Al-Rahmah (410) 747-4869. Registration confirmations from
Al-Rahmah Summer Camp will be mailed as soon as this form, shot records, and
payment in full are received. Contact Al-Rahmah Summer Camp for payment plan
information. Withdrawals and refunds are reviewed and given on a case by case
basis.

Please fill out a financial aid form if you require financial Assistance.

**Please follow STEPS 1- 4 to complete your

registration**

STEP ONE: REGISTRATION INFORMATION

Student Name: _______________________________________________

Age: _____ Date of Birth: _________ Sex:_____

Student email address: __________________________________

School: _______________________ Parent Name: _______________________________

Parent Email Address: ____________________________

Employer: _________________________________

Day Phone: _________________ext _______ Evening Phone: ____________

Cell Phone: ______________

Home Address: __________________________________________________

__________________________________________
City: _______________________________ State________ Zip: ___________

How did you hear about our camp? (Circle One)

A Friend/ Other/ ISB: (if other please Specify)________________________

STEP TWO: PAYMENT

Al-Rahmah Summer Camp 2009 will be conducted over two sessions. Each session
consists of a 2 or 3 week period in which campers focus on an Islamic theme,
accomplishes many hands-on activities, learn new crafts and skills, attend interactive
workshops given by various speakers and various educational and interesting field trips.

Please check the following sessions you will be enrolling your child in:

⃞ Session I: June 29th to July 10th “Lives of the Sahaba (RA) ” $115 per Child

⃞ Session II: July 13th to July 30th “Loving the Prophet (SAW)” $175 per Child

⃞ Both sessions $290 per Child

There is a $10 nonrefundable registration fee for all campers.

Register for BOTH sessions before June 1st to receive the 10% Early Bird Discount.
There is an additional 10% discount per sibling. There is NO discount (including sibling
discount) for registering for only one session. For your convenience there is a new per
week payment option. This option is for those parents who would like to add a week to
the session, but not attend the whole session. The fee for this option is $80 per child
with No discounts for any of the children. FULL payment is due by June 20th 2009, or
Early Bird Discount will be cancelled. If you require Financial Aid, please fill out a
Financial Aid form.

BEFORE and AFTER CARE

The cost and times for Before and After Care are as Follows. Parents must sign their
children in and out of camp when arriving and leaving from the care.

Before Care 8:00-8:45 A.M. $20 per session, or $40 for all 5 weeks
After Care 3:30-5 P.M. $40 per session, or $80 for all 5 weeks

Siblings receive a 20% discount for before and aftercare.

Note: Any child leaving after 5:00 PM will be fined $1 per minute
Enclosed payment $_________

Payment Type (circle one) Check/ Money Order/ VISA/MasterCard

Cash Amount $________ Check Number __________

Credit Card Information (See Office for more info)
STEP THREE: PERMISSION FORM/AGREEMENT

My child, __________________________________, has my permission to participate in

Al-Rahmah Summer Camp 2009.

I understand that as a part of Al-Rahmah Summer Camp, my child/ward may be

videotaped, audiotaped, interviewed, and/or photographed and agree to allow Al-
Rahmah Summer Camp to keep, as their property, the products of such videotaping,
audio taping, interviewing, and/or photographing and I agree that such material, along
with my child’s name may be used for promoting the Al-Rahmah Camp program and in
any publicity generated by Al-Rahmah Summer Camp. I also understand that my
child/ward may be asked to create projects that may also be used by Al-Rahmah
Summer Camp for publication in a variety of forums including the Al-Rahmah Summer
Camp website, and other publications, and that no compensation will be paid for such
use.
I agree to all of the camp rules/regulations, authorization for treatment, the registration
policies, and payment procedures as listed in the Summer Camp manual.
We, the parent(s) of the above stated camper understand and acknowledge that there
are inherent risks and dangers in some of the activities and programs offered by Al-
Rahmah Summer Camp, in cooperation with outside vendors/providers. I/We hold the
Al-Rahmah Summer Camp harmless of any accidents/injuries relating to the activities,
programs, and transportation services rendered by the company. I/We release Al-
Rahmah Summer Camp of all legal responsibility and liability.

"AGREEMENT TO PARTICIPATE, ASSUMPTION OF RISK INDEMNITY AGREEMENT

AND RELEASE OF LIABILITY"
that states in part, "The undersigned also agrees to hold harmless and unconditionally
indemnify [the camp], its Owners, Trustees, Directors, Officers, Employees, Agents,
and/or Associates either to participant's person, property or both, or of any other person
or party having a legal interest in participant's property or person, including but not
limited to accidents, damages, or injuries caused by either, in whole, or in part by any
negligent act or omission of Programs or [the camp], its Owners, Trustees, Directors,
Officers, Employees, Agents, and/or Associates of either including but not limited to [the
camp]'s sole negligence."

And later,

"Both parties irrevocably consent and submit to the jurisdiction and venue of the State
and Federal Courts having jurisdiction of Baltimore County, Maryland in connection with
any suit, action, or other proceeding concerning this Agreement and Release. If any
dispute results, then both parties agree to binding arbitration. If any provision of this
Agreement and Release is found to be unenforceable by a Court of the last resort, it is
the parties' intention that the Court should reform the unenforceable provision so as to
best approximate the parties' intent, and to enforce the provision as reformed."

_____________________ ________________________
Parent/Guardian Signature Date

STEP FOUR IS A SEPARATE FORM. REGISTRATION CANNOT BE

COMPLETED WITHOUT IT