Summer Youth Leadership Camp 2022 Summer Youth Camp Registration 2022Summer Youth Camp Registration 2022For any questions or concerns with the form below, please email summercamp@islam.caParent InformationParent First Name(Required) First Name Last Name Email(Required) Home Phone NumberCell Number(Required)Address(Required) Street Address Address Line 2 City State / ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Child(ren) InformationPlease note that this youth camp is for those who are 13 – 15 years old. Child 1 – Name(Required) First Last Child 1 – Date of Birth(Required) MM slash DD slash YYYY Child 1 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 1 Total Cost Price: $ 0.00 CAD Child 1 – Medical Conditions(Required)Child 1 – Medication Carried(Required)Child 1 – Other Information(Required)Register A Second Child?(Required) Yes NoChild 2 Name(Required) First Last Child 2 – Date of Birth(Required) MM slash DD slash YYYY Child 2 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 2 Total Cost Price: $ 0.00 CAD Child 2 – Medical Conditions(Required)Child 2 – Medication Carried(Required)Child 2 – Other Information(Required)Register A Third Child?(Required) Yes NoChild 3 Name(Required) First Last Child 3 – Date of Birth(Required) MM slash DD slash YYYY Child 3 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 3 Total Cost Price: $ 0.00 CAD Child 3 – Medical Conditions(Required)Child 3 – Medication Carried(Required)Child 3 – Other Information(Required)Register A Fourth Child?(Required) Yes NoChild 4 Name(Required) First Last Child 4 – Date of Birth(Required) MM slash DD slash YYYY Child 4 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 4 Total Cost Price: $ 0.00 CAD Child 4 – Medical Conditions(Required)Child 4 – Medication Carried(Required)Child 4 – Other Information(Required)Register A Fifth Child?(Required) Yes NoChild 5 Name(Required) First Last Child 5 – Date of Birth(Required) MM slash DD slash YYYY Child 5 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 5 Total Cost Price: $ 0.00 CAD Child 5 – Medical Conditions(Required)Child 5 – Medication Carried(Required)Child 5 – Other Information(Required)Register A Sixth Child?(Required) Yes NoChild 6 Name(Required) First Last Child 6 – Date of Birth(Required) MM slash DD slash YYYY Child 6 – Weeks Attending(Required) Week 1 – $40 (July 4-8) Week 2 – $40 (July 11-15) Week 3 – $40 (July 18-22) Week 4 – $40 (July 25-29) Week 5 – $40 (August 1-5) Week 6 – $40 (August 8-12) Week 7 – $40 (August 15-19)Select AllChild 6 Total Cost Price: $ 0.00 CAD Child 6 – Medical Conditions(Required)Child 6 – Medication Carried(Required)Child 6 – Other Information(Required)Other InformationEmergency Contact Name(Required) First Last Emergency Contact Phone Number(Required)#2 Parent/Guardian Name (Optional): First Last #2 Parent/Guardian Number (Optional):#3 Parent/Guardian Name (Optional): First Last #3 Parent/Guardian Number (Optional):Payment InformationWe will make every effort to accommodate each child; however there may be situations where a child has needs which our staff are not equipped to address. We reserve the right to limit registration in such circumstances.Field-trip costs not included and varies depending on the destination – attendance is optional. Camp runs Mon. – Fri, 9 am – 3:30 pm. No discounts for partial attendance. Lunch/snacks must be provided.How Will You Be Paying?(Required) Cash / Cheque Credit/Debit CardCredit Card(Required)Please check if you have activated a Stripe feed for your form.If you have selected cash or cheque, please ensure you bring it to the IIT office on the first day that your child is attending (or prior). Total Liability WaiverConsent I recognise that a risk of injury or potential health risks may exist in participation in the above named program/activity. I hereby willingly assume such risks for the above named person for whom I am in law responsible and assume full responsibility during and after their participation in the program. The Islamic Institute of Toronto (IIT) cannot be responsible for risk willingly assumed, and I therefore hereby release and forever discharge the IIT from all actions, damages, claims and demands whatsoever arising from participation in the program or any associated activities. I have read, understood and agree to the contents of this consent in its entirety.SignatureΔ