Program Registration ~ MOHID ©

Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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ICSI Lions - Soccer Spring 2024

16
MAR

12:00 AM

20
JUN

12:00 AM

Program Fee:

One Time: $250.00

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Player First Name*

Player Last Name*

Player Address *

Parent First Name*

Parent Last Name*

Parent Phone *

Parent Email *

Player School *

Player DOB*

Do you need a uniform? If yes, What is the size ?*

if you need a uniform, pick 3 jersey numbers preference. *

Is your child registered in Inara Academy?*

Is your child registered in Tarteel Academy?*

Is your child registered in a FULL TIME Islamic School?*

I understand my child must be registered in one of the above*

If registered, I understsand I must submit proof of Inara*

If registered, I understsand I must submit proof of Tarteel*

If registered, I understsand I must submit proof of School*

I understand, all girl uniforms are long sleeves and pants*

+ Add More Registrants

3 Payment

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

eCheck/ACH titleIcon

Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

Agree Decline

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Masjid for your and other community member's safety. You understand that your child's registration is not complete until they are registered in Tarteel Academy or Inara Academy. If your child is not registered in either programs, they must submit proof that they attend a full time Islamic School with a progress report that reflects grades and behavior. I understand that the code of conduct must be followed, or there will be consequences. I understand that if my child drops from Inara Academy or Tarteel Academy, they will be dropped from the Sports Program.

Islamic Center of Staten Island

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ICSI Lions - Soccer Spring 2024

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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