Summer Camp Registration Form

The Perfect Camp for Kids (and Parents!) Who Want It All , Without the Full Summer Commitment

Our 2-week Shams Stars Summer Camp is the perfect balance of faith, fun, and flexibility! Whether you're planning a vacation later in the summer or simply want your child to enjoy an uplifting break filled with creativity, character-building, and connection this is the camp for you.In just two weeks, your child will dive into inspiring Islamic learning, life skills, hands-on projects, outdoor fun, field trips and more all while making new friends and lasting memories. Spots are limited -reserve your child’s place today!
Camper's Name*

First NameLast Name
Camper's Birth Date*

MonthDayYear
Current School Name*
Gender*

MaleFemale
Does your child have any allergies?*
Tell us about your child’s Qur’an progress so far (reading & memorization)*
Any Dietary Restrictions ?*
Would you like to register another child?

YESNO
Camper's Name*

First NameLast Name
Camper's Birth Date*

MonthDayYear
Current School Name*
Gender*

MaleFemale
Does your child have any allergies?*
Tell us about your child’s Qur’an progress so far (reading & memorization)*
Any Dietary Restrictions ?*
Parent/Guardian Information
Mother's Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Father's Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Interested in being a chaperone for our field trips? Note: All chaperones must be 18+ and available on [Thursday,June 5th & Friday,June 13th ]*

Yes, I’m available to chaperoneMaybe-Keep me as a backupNo , not this time
Help us get to know your child better! Feel free to share any special instructions, preferences, or information that will help us support your child.
Interested in a Social Media Internship? We are looking for enthusiastic individuals to help manage our camp's social media presence. If you're interested or know someone who might be, please contact us at (224) 836-1086. Interns will enjoy exclusive perks!

Yes, I am interested in the Social Media Internship.I know someone who might be interested.No, not at this time.
How did you hear about our Summer Camp?

Social Media (Instagram, Facebook, etc.)Word of MouthSchool or Community EventFlyer/Postcard
If someone referred you, please provide their name: (We’d love to know so we can thank them!)
Please review our Parent Handbook
Parent Handbook Agreement*

I have read and agree to the terms in the Parent Handbook

CAMP FEE

REGISTRATION

$200.00 Quantity

Week 1

June 2- June 6

$100.00 Quantity

Week 2

June 9- June 13

$100.00 Quantity

FIELD TRIP

$25.00 Quantity

BEFORE CARE ONLY

8am - 10am

$90.00 Quantity

AFTER CARE ONLY

2pm - 5pm

$110.00 Quantity

BEFORE & AFTER CARE

8am-10am & 2pm-5pm

$200.00 Quantity

Enter coupon

Total

$0.00

Payment Instructions

Please send the total amount to :

Name: Shazia Hadi
Zelle: (224) 410-5253
Memo : Include your child’s full name in the payment memo.
Upload Payment Screenshot*

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The Perfect Camp for Kids (and Parents!) Who Want It All , Without the Full Summer Commitment