Summer Camp Registration Form

Come join us for three amazing weeks of fun and learning! Camp Triple A (Awake, Aspire, Act) will be in person at Islamic Center of Pittsburgh with a Field Trip on the last day. The camp will be Mondays through Thursdays, 10 AM to 2 PM, from June 13th to 30th, 2022. The Summer Camp will consist of Qur’anic Studies, Islamic Studies and Arabic, Hifz Classes (Based on qualification), and Daily STEAM Activities! Hot Lunch will be served at no additional cost. $175 for the first child and $165 for any additional child. We hope to see you there, inshaaAllah!

Register your child for the 2022 Summer Camp today!

*Note: Filling out the form below will not complete the registration process. Tuition must be paid in full before the start of the summer camp to ensure your child’s participation in the program. We accept credit card (call us at (412) 241-2124), cash or checks (payable to the Universal Academy of Pittsburgh).

Volunteers apply here, please.

* Indicates required field

Parent / Guardian Name *

Parent / Guardian Phone Number *

Address *

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Line 2

City

State

Zip Code

Country

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

I understand that my child must be dropped off at 10:00 am *

Agree Disagree

I understand that my child must be picked-up by 2:00 pm or an additional fee may be applied *

Agree Disagree

I understand that my child must display positive behavior during camp *

Agree Disagree

Student Name *

First

Last

Age *

Allergies/Special Accommodations *

Student Name 2 *

First

Last

Age *

Allergies/Special Accommodations *

Student Name 3 *

First

Last

Age *

Allergies/Special Accommodations *

Video Recording Consent: I am aware and I AGREE that the ICP/UAP may be recording sessions during Camp Triple A. The ICP/UAP may be using these recordings to promote awareness of the program in presentations, flyers, brochures, and on the ICP/UAP websites and social media platforms. We cannot enroll your child(ren) if you disapprove the recording consent. Please put your initials to indicate your agreement. *

Photo Release Statement: I am aware that the ICP/UAP may be taking pictures during sessions of Camp Triple A. The ICP/UAP may be using these photographs to promote awareness of the program in presentations, flyers, brochures, and on the ICP/UAP websites and social media platforms. Please indicate below whether you give permission to the ICP/UAP to photograph your child(ren). *

Release and Waiver Statement: I am leaving my child/children with the ICP/UAP Camp Triple A. I forever release and discharge the ICP and UAP, all of their employees, all of their agents, all of their members and managers, and the staff of this program for any liability that may occur during my child's participation. I AGREE in consideration for my child's participation in all ICP/UAP services to the following: I AGREE to release the ICP/UAP from all claims for money damages. I AGREE to pay any losses, damages, or costs incurred and to hold the ICP/UAP harmless with respect to claims for harm to my child. I am a parent/guardian of a minor and I consent to the child's participation and AGREE to all of the provisions and AGREE to assume all of the obligations of this release on the child's behalf. I AGREE that the ICP/UAP as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers, staff and affiliated organizations. I further AGREE to be bound by all applicable ICP/UAP rules, terms and provisions of the organization. *

Signature: I verify that the above information is accurate and complete. I also have read and understood the video recording consent, release and waiver statement, and photo release statement. By typing in your name in the below field, you e-sign your signature to all of the above information. *

Today's Date *

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Summer Camp Payment

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We are Social

Email: info@uapschool.org
Phone: 412-241-2124
Fax: 412-241-2123

Contact Us

Our Location

Universal Academy of Pittsburgh
2103 Hampton Street
Pittsburgh PA 15218

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