Youth Ilm Summer Camp Registration
You can register more than one youth in this form. If you have any questions, email education@masbayarea.org
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Youth Information
Youth Name
*
First Name
Last Name
Youth or Parent Phone Number
*
Format: (000) 000-0000.
Youth Email
*
example@example.com
Gender
*
Male
Female
Age
*
Grade (2025-2026 Academic Year)
*
School Type
*
Public
Islamic
Homeschooling
Other
Allergies/Medications if any?
*
Write N/A if not applicable
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Parent Information
First Parent Name
*
First Name
Last Name
First Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
First Parent Email
*
example@example.com
Second Parent Information
Emergency Contact (Please enter contact information for an emergency contact (different than parent) who we can contact in case parents cannot be reached)
*
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How many additional children are you registering?
*
None
1
2
3
2nd Child Information
*
3rd Child Information
*
4th Child Information
*
Youth Ilm Summer Camp
*
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( X )
1st Youth - Ilm Summer Camp
Youth
$400
$
400
2nd Child - Ilm Summer Camp
$380
$
380
3rd Child - Ilm Summer Camp
$360
$
360
4th Child - Ilm Summer Camp
$360
$
360
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
Participation Consent/Waiver
*
I hereby grant consent for my child to participate fully in the program and all associated activities, including surveys used to inform future programming, unless I provide written notice otherwise. MAS Bay Area reserves the right to restrict or prohibit participation if my child is not following program rules and may remove any participant from the program without refund if they fail to comply with rules or engage in behavior that is harmful to others.
Liability/Medical Waiver
*
By submitting this form, I release and agree to indemnify and hold harmless MAS Bay Area and its officers, employees, agents, and volunteers from any liability, claims, damages, or costs arising from my and/or my child’s participation in MAS Bay Area events, classes, camps, and activities, whether conducted at MAS Bay Area Office or any other sites where such events may take place. In the event of a medical emergency, MAS Bay Area personnel will make every reasonable effort to contact me or the listed emergency contact. In the case we cannot be reached, I authorize the MAS Bay Area designated personnel to treat my child for any injuries, illnesses, or conditions that may occur at the camp/activity. This includes onsite and offsite emergency care.
Photo Release Authorization
*
I grant permission for photos or videos taken of me or my child(ren) during MAS Bay Area events/classes/camps/activities to be used on the MAS Bay Area website, in brochures, on social media, and in newsletters for promotional, educational, or informational purposes.
I do not give permission to be photographed, and if I am, I request that my photo not be published.
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