Summer Youth Leadership Camp 2022

Summer Youth Camp Registration 2022

For any questions or concerns with the form below, please email summercamp@islam.ca

Parent Information

Parent First Name(Required)

Email(Required)

Home Phone Number

Cell Number(Required)

Address(Required)

Child(ren) Information

Please note that this youth camp is for those who are 13 – 15 years old.

Child 1 – Name(Required)

Child 1 – Date of Birth(Required)

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)

Child 1 Total Cost

Price: $ 0.00 CAD

Child 1 – Medical Conditions(Required)

Child 1 – Medication Carried(Required)

Child 1 – Other Information(Required)

Yes

Child 2 Name(Required)

Child 2 – Date of Birth(Required)

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)

Child 2 Total Cost

Price: $ 0.00 CAD

Child 2 – Medical Conditions(Required)

Child 2 – Medication Carried(Required)

Child 2 – Other Information(Required)

Yes

Child 3 Name(Required)

Child 3 – Date of Birth(Required)

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)

Child 3 Total Cost

Price: $ 0.00 CAD

Child 3 – Medical Conditions(Required)

Child 3 – Medication Carried(Required)

Child 3 – Other Information(Required)

Yes

Child 4 Name(Required)

Child 4 – Date of Birth(Required)

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)

Child 4 Total Cost

Price: $ 0.00 CAD

Child 4 – Medical Conditions(Required)

Child 4 – Medication Carried(Required)

Child 4 – Other Information(Required)

Yes

Child 5 Name(Required)

Child 5 – Date of Birth(Required)

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)

Child 5 Total Cost

Price: $ 0.00 CAD

Child 5 – Medical Conditions(Required)

Child 5 – Medication Carried(Required)

Child 5 – Other Information(Required)

Yes

Child 6 Name(Required)

Child 6 – Date of Birth(Required)

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)

Child 6 Total Cost

Price: $ 0.00 CAD

Child 6 – Medical Conditions(Required)

Child 6 – Medication Carried(Required)

Child 6 – Other Information(Required)

Other Information

Emergency Contact Name(Required)

Emergency Contact Phone Number(Required)

#2 Parent/Guardian Name (Optional):

#2 Parent/Guardian Number (Optional):

#3 Parent/Guardian Name (Optional):

#3 Parent/Guardian Number (Optional):

Payment Information

We 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 Card

Credit 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 Waiver

Signature

Summer Youth Camp Registration 2022

Parent Information

Child(ren) Information

Other Information

Payment Information

Liability Waiver

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Islamic Institute of Toronto

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