23rd National Junior Muslim Youth Camp (Ages 11-15yrs)
Student Enrolment to be completed by a parent/guardian aged 18 and over.
Have you previously attended a YMA Camp?
*
Yes
No
Why would you like to attend this camp?
How did you hear about the camp?
*
Facebook
Instagram
Email
Friends
Saturday Madrasah
Sunday Madrasah
Word of Mouth
School brochure
Poster
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Student Information
Personal information about the Student applying.
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Gender
*
Please Select
Male
Female
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Mobile Number
*
Student mobile number (Or the best contactable number).
E-mail
*
Student Email Address
Name of academic School
*
School Class Year
*
Grade level in the current year
Jumper Size
*
XXS
XS
S
M
L
XL
XXL
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Medical Conditions
It is essential that staff are aware of any medical conditions your child may have to best cater for them.
Do you have any diagnosed Medical conditions?
*
If you are diagnosed with Asthma or Anaphylaxis you are required to bring your medication to the camp.
Do you have any behavioural or learning challenges?
*
This is to inform team leaders and staff to ensure your child's needs are best accommodated for.
Do you have any special dietary requirements?
Medicare Number
*
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Emergency Contact
Information about a parent/guardian/next of kin for the student (must be aged 18 years and older)
Name
*
First Name
Last Name
Relationship to student
*
Mobile Number
*
Phone Number
-
Area Code
Phone Number
E-mail
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
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Photography & Film Permission
For purposes of documentation, marketing, and evaluation, it is necessary to take photos/videos of students. Images may be used for printed publications, online and social media activities.
Photography & Filming Permission
*
Please Select
I give photo / film consent
I do not give photo/film consent
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Declaration
By ticking the box below you are agreeing that the above information is correct and you will inform YMA of any changes to details.
To be completed by a parent / legal guardian.
*
I agree that the above information is correct.
Comments
Any additional information you would like to provide.
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Fees
Payment of fees is a requirement to secure your attendance.
Please choose from one of the following payment options
*
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( X )
3 x Fortnightly Installments (NJMYC)
(
$
133.00
AUD
for each
two weeks
)
2 x Fortnightly Installments (NJMYC)
(
$
199.50
AUD
for each
two weeks
)
Full Payment (NJMYC)
(
$
399.00
AUD
for each
year
)
Cash payment
(
$
Free
AUD
for each
year
)
Must be approved by camp admin. Call Abdul-Kareem on 0425 617 975
Total
$
0.00
AUD
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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