Youth Activities Form - 6 Weeks Holiday

Youth Activities Form - 6 Weeks Holiday
Sessions will take place:

• Dates: Starting from Monday 20th July 2026 - Wednesday 26th August 2026
• Days: Every Monday, Tuesday and Wednesday
• Time: 11:00am – 1:30pm

Each session includes:

• 2 hours of engaging youth activities
• 30 minutes of Islamic Tarbiyah

Fee: Non-refundable £40 per child for full school holidays
Do you already attend Masjid Maryam Youth Club?
Youth name

First NameLast Name
Youth Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearMust be 10-15 years old
Youth Phone Number
Please enter a valid phone number if applicable.Format: 07000000000.
Youth Email
Please enter a valid email if applicable
Address

Street Address

Street Address Line 2

CityState / Province

Postal Code
Does the child have any allergies?
Does the child have any medical conditions that we should be aware of? (Please include any SEN needs here)
Parent/Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 07000000000.
Relationship
Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid UK phone number.Format: 07000000000.
Relationship
Acknowledgment
- I agree to follow the guidelines, rules, and policies of the Masjid.
- Concerns regarding behaviour may lead to further action, including suspension or expulsion.
- Parent/Guardian registered in this form has legal custody over the child.
- For medical emergencies, I allow the medical team of this organization to take care of my child.
- By completing this form you allow your child to be photographed or be part of videos that will be used for marketing, promotion and advertisements.
Parent/Guardian Signature
Should be Empty:

Youth Activities Form - 6 Weeks Holiday

Parent/Guardian Information

Emergency Contact

Acknowledgment