Manitoba Islamic Association Summer Day Camp Registration

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Please fill out all sections of this registration form and submit. Camp Staff will contact you regarding fee payment and confirmation of registration (camp may fill up, so this confirmation is important).

* Please Note: We have limited space, registration is based on a first come, first serve basis.

Email *

Camper First and Last Name: *

Campers Permanent Resident Card #:

Camper Birth Date DD/MM/YYYY *

Age: *

Gender: *

Female

Male

Required

Camper resides with: *

Both parents

Mother

Father

Other

Health Number and PHIN: *

Allergies: *

Additional Camper (2) First and Last Name:

Camper's Permanent Resident Card # (if applicable)

Additional Camper (2) Birth Date DD/MM/YYYY:

Additional Camper (2) Age:

Additional Camper (2) Gender:

Female

Male

Clear selection

Additional Camper (2) Resides with:

Both Parents

Mother

Father

Other

Clear selection

Additional Camper (2) Health Number and PHIN

Additional Camper (2) Allergies:

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