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 AlRahmah 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 AlRahmah 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 AlRahmah 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