Summer Camp 2026
Registering for
Student Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date of Birth
Grade (Year 2025-2026)
*
Please Select
Pre-k
K
1
2
3
4
5
6
School
*
School District
*
Allergies
*
To make it easier for us to understand and accommodate your child(ren)'s needs, please add any additional Educational Information about your child below (i.e. ADHD, Dyslexia, etc.) We would like to ensure the safety and value of your child(ren)'s enjoyment at our Camps as much as possible. (Note: You may put "N/A", if applicable)
*
2 - Student Name
*
First Name
Last Name
2 - Grade
*
Please Select
K
1
2
3
4
5
6
2 - School
*
2 - School District
*
Mother Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorized Pickup
*
Mother (as mentioned above)
Father (as mentioned above)
Other
Relation to the child
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mandatory Pickup/ Drop-Off Policies and Procedures
*
PAYMENT
Minimum 4 Weeks Required
Registering For: Select all that applies
*
Full Day: 10:00 am - 3:00 pm
Half Day: 9:00 am - 12:00 pm
Half Day: 12:00 pm - 3:00 pm
Select your preferred weeks (Minimum 4 weeks)
*
Categories:
All
All
July
August
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next
( X )
July
July 6 - July 10
$249.00
$
249.00
Timings
10 am - 3 pm
9 am - 12 pm
12 pm - 3 pm
July 13 - July 17
$249.00
$
249.00
Timings
10 am - 3 pm
9 am - 12 pm
12 pm - 3 pm
July 20 - July 24
$249.00
$
249.00
Timings
10 am - 3 pm
9 am - 12 pm
12 pm - 3 pm
July 27 - July 31
$249.00
$
249.00
Timings
10 am - 3 pm
9 am - 12 pm
12 pm - 3 pm
August
Aug 3 - Aug 7
$249.00
$
249.00
Timings
10 am - 3 pm
9 am - 12 pm
12 pm - 3 pm
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Per Day: Select your preferred Week(s)
*
Week 1: May 27 - May 30(May 26 Closed)
Week 2: June 2- June 5(June 6th Closed)
Week 3: June 10- June 14
Week 4: June 16 - June 20(June 17 closed)
Week 5: June 23 - June 27
Week 6: June 30 - July 5(July 4 Closed)
Week 7: July 7 - July 11
Week 8: July 14- July 18
Week 9: July 21 - July 25
Week 10: July 28 - August 1
Week 11: Aug 4 - Aug 8
Per Day: Select your preferred day for the above selected week
*
Monday
Tuesday
Wednesday
Thursday
Friday
Enrollment & Payment Agreement
Please Read Carefully & Sign Below:
*
By signing below, i agree to the above Enrollment Agreement.
*
Date of Consent
*
-
Month
-
Day
Year
Date
How did you hear about our summer camp?
*
Please Select
Facebook
Email
Instagram
Whatsapp
Friend
Masjid Newsletter
GEM Newsletter
Back to School Fair
Representative called
Received postcard
Other
Submit
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