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Camp Mu'mineen Online Registration Form 2017
Child's Full Name:
Child's Date of Birth
Shirt Size
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
2nd Child's Full Name:
2nd Child's Date of Birth
Shirt Size
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
3rd Child's Full Name
3rd Child's Date of Birth
Shirt Size
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Parent/Guardian Information
Parent/Guardian's Full Name
Email Address:
Cell Phone
Alternate Phone
Home Address
In case of an emergency, who else can we contact?
Emergency Contact's Name
Relation to Child
Mother
Father
Aunt
Uncle
Grandparent
Family Member
Family Friend
Emergency Contact's Phone
Medical Information
Name of Child's Doctor
Doctor's Phone
List child's name with along with any known allergies.
Check to confirm
I understand that there is a one-time registration fee of $50/child due before July 10, 2017. ***LATE FEE of $10 will apply after July 10th.***
Fees will cover camp expenses including field trip admissions and camp t-shirt. I must provide lunch for my child each day.
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