Household / Adult Primary Contact

Number of campers you want to register today *

Parent's/ Guardian's First Name *

Last Name *

Relationship to Camper *

Mother

Father

Guardian

Other Other

Address 1 *

City *

State *

Zip *

Cell Phone *

Home Phone:

Email Address *

Confirm Email Address *

Please email me updates (You MUST Check this box if you want to receive a confirmation email with important camp related documents like packing list, advisor contact information, dress code, etc)

Would you be available as an adult volunteer for this camp? We need only one general chaperone/volunteer for this camp. (You will be required to go through an official background check to confirm eligibility.) *

YES

Referral:

Did someone or something refer you to this MYNA Camp? Please tell us who!

Second Emergency Contact Person

First Name *

Last Name *

Relationship to Camper *

Mother

Father

Guardian

Other Other

Cell Phone: *

Home Phone

Email Address *

Confirm Email Address *

NOTICE: All cell phones will be turned over to counselors at the beginning of camp and may only be used at pre-determined times at the end of each day, and under certain circumstances during recreation time. That usage is at the counselor’s discretion. Campers will be reminded to contact their parents first during daily phone time. All phones will be returned to campers on the last day of camp. (Please ensure that the campers you register are aware of this policy. *

Please email me updates (You MUST Check this box if you want to receive a confirmation email with important camp related documents like packing list, advisor contact information, dress code, etc)

Muslim Youth of North America (MYNA)

P.O. Box 38

Plainfield, IN 46168