MCC Youth Camp 2020 Camper Registration
Girls: June 7th - June 13th *GIRLS CAMP IS NOW WAITLIST ONLY*
Boys: June 7th - June 13th

Girls' & Boys' Camp Location: 2 semi-separate campsites in Michigan (Girls) and Michigan (Boys). The campers will spend one day in a supervised co-ed environment to allow for healthy discussions on gender relations that are typically neglected. For the other 6 days, the boys will be at a completely separate, but nearby, campsite.

Fee: $450 for each camper, no discounts for group registration. Please pay by check.

Ages: 12-18 years old when camp begins

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
Is this the camper's first time being away from home for a long time? *
Camper Phone Number
Your answer
Parent/Guardian #1's Full Name *
Your answer
Parent/Guardian #1'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
Parent/Guardian #1's Home Phone
Your answer
Mother/Legal Guardian Cell Phone *
Your answer
Parent/Guardian #2's Full Name *
Your answer
Parent/Guardian #2'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
Parent/Guardian #2's Home Phone
Your answer
Parent/Guardian #2's Cell Phone *
Your answer
Camper's Shirt Size *
What is the closest masjid to you or the masjid you attend most frequently (this is for statistical purposes and helps us so we know which masjid are represented at camp)
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
Can your child take Ibuprofen/Advil? *
Can your child take Acetaminophin/Tylenol? *
Is your camper vegetarian?
Does the camper have the updated immunizations required for school? *
What school district does your camper attend? This is for statistical purposes and how we plan future camps
Your answer
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
Campers often open up about issues in their life (divorces, deaths, stress, eating disorders, moving to a new school, etc). Are there any issues about your camper that we ought to be sensitive to or that will help us be better counselors for them? *
Your answer
We are proud that our campers come from ALL financial backgrounds. This allows our campers to contribute to the week with a variety of experiences and viewpoints. If you are able and would like to contribute financial assistance for campers registration fees, please let us know below.
The waiver form and health insurance form, which will be emailed to you within a week, MUST be signed by a legal guardian and the camper in order to be accepted to attend the camp. Payment must be mailed as a check. In all, the waiver forms, the health insurance form, and the check must be put in the same envelope. You will receive an email shortly with forms and the mailing address attached. If you would like to pay online, there is an additional $13 processing fee added. Email myccamp2013@gmail.com for more information. Please check to box to indicate you have read and understood the statement. *
Required
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.

Contact myccamp2013@gmail.com for questions
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