MCC Youth Camp 2017 Camper Registration
Program Date:

Boys: July 23-29, 2017 ********BOYS REGISTRATION IS CLOSED, register for waiting list only.*****************
Girls: August 6-12, 2017

Girls' & Boys' Camp Location: Illinois
Fee: $400
Ages: 12-18

To register please complete the information below and then click the "Submit" button.

Fee Includes:
Overnight Accommodations (room and board)
Food
Transportation
All religious and recreational activities

Camper Last Name
Your answer
Camper First Name
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Birthdate
(mm/dd/yyyy)
Your answer
Age
(Age camper will be by the first day of camp)
Your answer
Gender
Camper Email
Please include an email address that you check regularly. This will be our primary form of communication.
Your answer
Camper Phone
Your answer
Mother's/Legal Guardian's Full Name
Your answer
Mother/Legal Guardian's Email
Please include an email address that you check regularly. This will be our primary form of communication.
Your answer
Address (if different from camper)
Your answer
Mother/Legal Guardian Home Phone
Your answer
Mother/Legal Guardian Cell Phone
Your answer
Father's/Legal Guardian's Full Name
Your answer
Father/Legal Guardian's Email
Please include an email address that you check regularly. This will be our primary form of communication.
Your answer
Address (if different from camper)
Your answer
Father/Legal Guardian Home Phone
Your answer
Father/Legal Guardian Cell Phone
Your answer
Shirt Size
What mosque/center do you regularly attend?
Please include the center's name and city.
Your answer
Health Information
Please list any special conditions (medications, allergies, dietary restrictions, etc) your child has. Be concise as there is a separate health form that is required.
Your answer
Does the camper have the normal immunizations required for school?
Medical Health Insurance Information
Name of Primary Insured, Insurance Carrier and Policy Number
Your answer
Physician Information
Primary doctor's name and phone
Your answer
The waiver form, which will be emailed, MUST be signed by a legal guardian and the camper in order to be accepted to attend the camp.
Confirmation
This registration form is complete when final payment is received. To proceed with the payment please click submit button and within the next few days you will be emailed with payment information. Thank You.
Submit
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