MAS Youth Camp Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has ClosedRegistration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Registration for the Youth Camp has Closed Number of Campers (siblings) Registering *OneTwoThreeFirst Camper InformationFirst Camper Name *FirstLastFirst Camper Sex *MaleFemaleFirst Camper Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920First Camper T Shirt Size *SmallMediumLargeXL2XL3XL4XLFirst Camper Medical Concerns or Food AllergiesSecond Camper Information Second Camper Name *FirstLastSecond Camper Sex *MaleFemaleSecond Camper Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Second Camper T Shirt Size *SmallMediumLargeXL2XL3XL4XLSecond Camper Medical Concerns or Food AllergiesThird Camper Information Third Camper Name *FirstLastThird Camper Sex *MaleFemaleThird Camper Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Third Camper T Shirt Size *SmallMediumLargeXL2XL3XL4XLThird Camper Medical Concerns or Food Allergies *Parent/Guardian InformationParent/Guardian Name *FirstLastParent/ Guardian Email *Parent/Guardian Phone *Parent/Guardian Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency ContactName *FirstLastPhone *Individual Ticket – Late Registration Price *Price: $250.00Prices will go up to $250 on August 8th. Two Siblings – Late Registration Price *Price: $500.00Prices will go up to $500 on August 8th. Three siblings – Late Registration Price *Price: $750.00012345678910Prices will go up to $750 on August 8th. TransportationYes, we will use the bus ride from Masjid Al-Ansar (OC) or Ar-Rahman Islamic Center (Fontana) for a $30 per camperTransport One CamperTransport Two CampersTransport Three campersSignature * Clear Signature By signing this form you agree to the conditions in or Name Transport By signing this Form you agree to all the conditions mentioned in MAS Camp Waiver Release of Liability Form Waiver Release of Liability !Coupon Apply Total$0.00Signed Waiver Form UploadStripe Credit Card *Credit Card field is disabled, Stripe payments are not enabled in the form settings.Submit
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