MAS Youth Camp Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.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 Information Food Transport Number Parent/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 – Early Registration Price *Price: $250.00Prices will go up to $300 on August 10thTwo Siblings – Early Registration Price *Price: $450.00Prices will go up to $550 on August 10th. Three siblings – Early Registration Price *Price: $650.00012345678910Prices will go up to $750 on August 10thTransportationYes, we will use the bus ride from Masjid Al-Ansar (OC) or Ar-Rahman Islamic Center (Fontana) for a $40 per camperTransport One CamperTransport Two CampersTransport Three campersMAS Camp Waiver – Release of Liability Form – View Right click and click Open in New Tab or click with the middle wheel button Signature * Clear Signature By signing this Form you agree to all the conditions mentioned in MAS Camp Waiver Release of Liability FormSigned Waiver Form UploadCoupon Apply Total$0.00Square *CardName on CardSubmit
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