Girls Youth Club – American Muslim Center

Parent/Guardian Information - Step 1 of 4

Parent/Guardian Name *

First

Last

Parent/Guardian Phone Number *

Parent/Guardian Email Address *

Confirm Email

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Information

Emergency Contact Name *

First

Last

Emergency Contact Relationship (ie. Mother, Father, Sibling, Family Friend, etc.) *

Emergency Contact Phone Number *

Save and Resume Later

Youth Girl's Name *

First

Last

Youth Girl's Phone Number *

Youth Girl's Date of Birth *

Has the youth Girl(s) attended Islamic Schools in the past?

If you answered yes to the question above, please Select from the dropdown menu which level your youth girl attended last in Islamic School? Otherwise, please indicate their grade level in full-time school.

Which languages are spoken in your household?

At this moment we are not able to accommodate youth girls with special needs, however we are looking to create accommodations. In an effort to find out what the community needs please fill out this section detailing any special needs of your youth girl.

Does the youth girl have any medical conditions or allergies? If so, please list them below.

Photo Permission

I hereby consent the American Muslim Center to take photos, or videos of this youth girl during the school year and use them on its social media, website, email, and or newsletter. This includes any recording, photos, or videos taken on remote learning platforms such as Zoom or Google Meet. I do this with full knowledge and consent and waive all claims for compensation for use or for damages.

Please select below *

Yes, I give consent for the American Muslim Center to photograph or videotape my child(ren).
No, I do not give consent for the American Muslim Center to photograph or videotape my child(ren).

How many youth girls are you registering? *

One
Two
Three
Four

Save and Resume Later

82 Spring St

(617) 294-1446

Monday through Sunday

Emergency Contact Information

Photo Permission

Disclaimer

The American Muslim Center is a pillar in the Greater Boston Muslim community.

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82 Spring St

(617) 294-1446

Monday through Sunday

Emergency Contact Information

Photo Permission

Disclaimer

The American Muslim Center is a pillar in the Greater Boston Muslim community.

Subscribe to our newsletter to receive updates about upcoming events, and news!

follow us

call us

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