Summer Camp Registration
Please fill out this form to register your children for our Summer Program.

The program runs for 4 days of the week, Monday - Thursday, from 9:30 AM - 1:00 PM for children ages 5 - 13.
We will start on July 5th and end on August 10th Insha'Allah.

The registration fee is $150 per child.
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Email *
Street Address *
City *
Parent 1 Full Name *
Parent 1 Phone Number *
Parent 2 Full Name
Parent 2 Phone Number
Emergency Contact Full Name *
Can be either parent or someone else. Someone who will answer the phone if a volunteer needs to call.
Emergency Contact Phone Number *
How many students are you registering? *
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