Young Youth Camp Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Camper InformationName *FirstLastSex *MaleFemaleDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of SchoolT Shirt Size *SmallMediumLargeXL2XL3XL4XLMedical Concerns or Food AllergiesParent/Guardian InformationParent/Guardian Name *FirstLastParent/ Guardian Email * Camp) Address Camper 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 Bird price *Price: $200.00Prices will go up to $250 on August 8th. Transportation Fee Optional (Please enter $30 if you want a Bus ride to Camp)This fee is optional. If you’d like to ride the bus departing from Masjid Al-Ansar (Orange County) or Ar-Rahman Islamic Center (Fontana), please submit payment. If you choose not to pay, you will be responsible for arranging your own transportation to the camp. You must enter $30 in the field above for it to count towards your transportation payment, if you are not intending to get transport with us leave it blank. Signature * Clear Signature By signing this form you agree to the conditions in http://masgreaterla.org/wp-content/uploads/2025/06/MAS-Camp-Waiver-Release-of-Liability.pdfCheckboxesI agreeBy checking Coupon Apply Total$0.00Stripe Credit Card *File Upload Click or drag a file to this area to upload. Submit
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