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EIC WIS Youth 2023-2024 Registration Form
Please submit this form to complete the registration for the Youth Program
on Fridays 6pm-7pm from September 15, 2023 to May 17, 2024.
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Email
*
Your email
How many children are you registering in the Youth Program?
*
If you are registering more than one child, then please make sure to submit the name and details of each child under the Additional Youth Registration section
Your answer
Tuition Payment Receipt Transaction ID
*
Please pay the tuition [$250 for the school year or $350 total if registering more than one child] for the EIC WIS 2023-2024 school year at
https://www.eicsanjose.org/wp/wisyouth
and copy the Transaction ID from the donation receipt and paste below. JazakAllahu khayran.
Your answer
Father's Full Name
*
Your answer
Father's Email Address
*
By providing your email address, you are agreeing to be included in our email distribution list.
Your answer
Father's Mobile Number
*
Please include area code
Your answer
Mother's Full Name
*
Your answer
Mother's Email Address
*
By providing your email address, you are agreeing to be included in our email distribution list.
Your answer
Mother's Mobile Number
*
Please include area code
Your answer
Home Address
*
format: street address, city, zip code
Your answer
Youth 1: Full Name
*
First and Last Name
Your answer
Youth 1: Is your child a returning student or a new student?
Returning
New
Clear selection
Youth 1: Gender
*
Female
Male
Youth 1: Age
*
EIC WIS Youth is for ages 11 - 18 years.
Your answer
Youth 1: Date of Birth
*
format: mm/dd/yyyy
Your answer
Additional Youth Registration
If you are registering more than one child, then please make sure to submit the name and details of each child
Youth 2: Full Name
Your answer
Youth 2: Is your child a returning student or a new student?
Returning
New
Clear selection
Youth 2: Gender
Female
Male
Clear selection
Youth 2: Age
EIC WIS Youth is for ages 11 - 18 years.
Your answer
Youth 2: Date of Birth
format: mm/dd/yyyy
Your answer
Youth 3: Full Name
Your answer
Youth 3: Is your child a returning student or a new student?
Returning
New
Clear selection
Youth 3: Gender
Female
Male
Clear selection
Youth 3: Age
EIC-WIS Youth for ages 11 - 18 years.
Your answer
Youth 3: Date of Birth
format: mm/dd/yyyy
Your answer
Youth 4: Full Name
Your answer
Youth 4: Is your child a returning student or a new student?
Returning
New
Clear selection
Youth 4: Gender
Female
Male
Clear selection
Youth 4: Age
EIC-WIS Youth for ages 11 - 18 years.
Your answer
Youth 4: Date of Birth
format: mm/dd/yyyy
Your answer
A copy of your responses will be emailed to the address you provided.
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