Summer Camp 2017
Register One child $140.00 CAD Register Two children $270.00 CAD Register Three Children $390.00 CAD Register Four Children $500.00 CAD

First Name (required)

Last Name (required)

Age (required)

School/Grade (required)

Name of Parent/Guardian (required)

Home Address (required)

Your Email (required)

Work Phone (required)

Home Phone (required)

Cell Phone (required)

Emergency Contact Name (required)

Emergency Contact Number (required)

Relation

I certify that the information on this form is complete and accurate. I understand that the Muslim Children of North America (MCNA) and Meadowvale Islamic center (MIC) will not be responsible for the enrolled student(s) after the teaching hours. I am to see that my enrolled student(s) are punctually brought and taken on time. I understand that the fee is due before the summer camp starts.
Students will not be permitted to leave early or arrive late without a written and signed note/phone call from the parent or guardian.
Please contact the teacher or executive committee members for any other queries or issues related to the Summer Camp.
I have read, understood and will abide by the rules and regulations of the Summer camp and usage of the Edenwood Middle School, a Peel District Public school facility in Mississauga.
Timings will be confirmed at the Time of Registration.

Parent/Guardian Signature

Date

Office Use only
Group

Student No.