Youth Summer Camp 2023 Youth Ilm Summer Program 2023 Step 1 of 4 25% Number of Youth Attending the Program:(Required)123First Youth InformationName of First youth(Required) First Last Email of First Youth (optional) Age of First Youth(Required) Grade of First Youth (coming academic year)(Required) Allergies and/or medications (if any)Second Youth InformationName of Second Youth(Required) First Last Email of Second Youth (optional) Age of Second Youth(Required) Grade of Second Youth (coming academic year)(Required) Allergies and/or medications (if any)Third Youth InformationName of Third Youth(Required) First Last Email of Third Youth (optional) Age of Third Youth(Required) Grade of Third Youth (coming academic year)(Required) Allergies and/or medications (if any) Parent’s Information and ConsentsParent’s Name(Required) First Last Phone Number(Required)Email(Required) Emergency Contact InformationName(Required) First Last Phone(Required)Email(Required) Terms and ConditionsParticipation Consent(Required) I hereby give consent for me and/or my child to participate in the full program and all activities including surveys used for the purpose of future programming unless I advise you in writing. MAS BA has the right to prevent any child from participation if he/she is not following the rules. MAS BA has the right to expel any child from the program if he/she's not following the rules or if he/she is causing harm to others, without refund I agreePhotography Consent(Required) I give permission for MAS to use any photograph of me and/or my child for promotional material I agreeDress Code(Required) I agree to abide by Islamic dress code for both boys and girls I confirmOne Camper Price: Two campers Price: Three campers Price: Total Youth Ilm Summer Program 2023 paymentCredit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CAPTCHA
