NOTE: If for some reason you are unable to use this Online Registration form,
email us at mycregistrar(at)yahoo.com and request a paper Registration Form.

FEES:
Full Week (6 nights):
1st camper (4th grade - Adult): $495
2nd camper in same family (4th grade - Adult): $470
3rd and additional campers (4th grade - Adult): $445
Elementary camper (age 5-8): $295 flat fee

Daily Rate:
$100 per person per day

DEADLINES: Registration is on a first-come, first-served basis. Registration forms must be received and fees fully paid (online or by postal mail) by June 15, 2010 in order to reserve a space. After this date, we will only accept registrations from campers in those groups that have not yet filled up. There will be NO on-site registration for cabin groups that have been filled to capacity. Check this website regularly for availability of space in each cabin group. Online registration is preferred.

MYC STAFF: Staff members (Counselors, Faculty, Administration, etc.) must be confirmed as staff each year by the MYC Executive Administrator. Confirmed staff members must use a separate individual online Staff Registration Form, and should not list themselves as campers below (though they may designate themselves as responsible parties in the Family Contact Information section). Children and spouses of Staff should register and pay as campers using this online Camper Registration Form. If you are interested in serving as MYC 2010 staff, please contact us with details about your educational, professional and personal experiences in the body of the message.

NOTE:
  • All information must be filled out
  • Include all members of the family attending camp (including children under 5, parents, and adults) for the same duration of time (if durations vary, use a separate form for each group of campers)
  • All campers under the age of 9 MUST attend the camp with one parent - no exceptions!
  • DO NOT include Staff adults on this form. Complete one form (up to six campers) per household. Members of an extended family (such as cousins) and any friends must use a separate form (even if sharing a household).


PERSONAL INFORMATION:
Enter information about each group of campers attending for the same duration (entire week or part of the week),
including parents/adults. Children under 5, including babies, are free, but please include
their registration information with rest of family.
Full week and Daily Rate pricing will be displayed on the next page based on information entered below.
FIRST NAME LAST NAME GENDER GRADE
THIS FALL*		 AGE AT
CAMP TIME		 BIRTHDAY
(mm/dd/yy)
CAMPER ONE
CAMPER TWO
CAMPER THREE
CAMPER FOUR
CAMPER FIVE
CAMPER SIX
* Indicate the camper's school grade as of this fall (such as 1, 2, 3, . . 12).
For children under 5, use the PS code.
For college level use: CFR = College Freshman, CSO = College Sophomore,
CJR = College Junior, CSN = College Senior, GS = Graduate Student.
Parents and Adults in general should use the code PG (Post-Graduate).


CAMP INFORMATION:
One t-shirt per camper is included in the registration fee.
T-SHIRT SIZE? SHORT OR
LONG SLEEVE?		 ATTENDED
MYC BEFORE?		 WHAT
YEAR?		 WHO WAS YOUR
COUNSELOR?
CAMPER ONE Short-sleeve   Long-sleeve Yes   No
CAMPER TWO Short-sleeve   Long-sleeve Yes   No
CAMPER THREE Short-sleeve   Long-sleeve Yes   No
CAMPER FOUR Short-sleeve   Long-sleeve Yes   No
CAMPER FIVE Short-sleeve   Long-sleeve Yes   No
CAMPER SIX Short-sleeve   Long-sleeve Yes   No

MEDICAL INFORMATION:
Please provide the following information for each camper listed above.
DOCTOR'S NAME
AND PHONE		 MEDICAL INSURANCE
COMPANY AND POLICY #		 KNOWN MEDICAL
CONDITIONS
CAMPER ONE
CAMPER TWO
CAMPER THREE
CAMPER FOUR
CAMPER FIVE
CAMPER SIX

FAMILY CONTACT INFORMATION:
Please provide the following information for the parents or responsible adults of the family of the camper(s) listed above.

Father’s Name:     Attending Camp? Yes   No
Father’s Age:     Occupation:  
Mother's Name:     Attending Camp? Yes   No
Mother’s Age:     Occupation:  
Address:   
City:     State:     Zip:   
Phone:     Mobile:    
In case of emergency contact:   at  
Parent or adult camper e-mail address:   (Required! We need this to contact you!)
Alternate e-mail address:  


©2010 Muslim Youth Camp of California

16027 Brookhurst Street, Suite G-170, Fountain Valley, CA 92708
Phone: Registrar (951) 264-0746 or General Info (714) 396-9196

The Muslim Youth Camp is a non-profit organization registered in the State of California.
Donations are tax-deductible. Federal EIN #35-2251548.