Al-Ansar Summer Youth Camp Registration Form:
Campers First Name
Your answer
Campers Last Name
Your answer
Gender:
Age:
Date of Birth:
MM
/
DD
/
YYYY
Grade:
Your answer
Father's Name:
Your answer
Father's Cell#:
Your answer
Mother's Name:
Your answer
Mother's Cell#:
Your answer
Home Phone#:
Your answer
Emergency Contact Name:
Your answer
Emergency Contact Phone#:
Your answer
E-mail:
Your answer
Address:
Your answer
Rules: ~Follow directions ~Behave as a good camper ~Respect all staff, our center (Masjid Al-Ansar), fellow campers, other properties on the field trips, follow safety policies at all times in the center and/or outside the center. ~Be on time. Consequences: ~1st time:Warning ~2nd time: remove from the cabin/class ~3rd time: call parents. ~If severe disruption reoccurs, the student will be suspended. (Fighting, stealing, leaving the premises without permission...etc )
Parents Cooperation Statement: I have read the camp rules, I have discussed it with my child and I agreed to enroll him/her based on those rules to the camp program.
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