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Summer Camp 2021 Registration

Darulimaan Summer Camp - 2021

Summer Camp Registration Form

Step 1 of 7

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Student Information
Please Provide Student information.
Number of Children*
- One
- Two
- Three
You can apply for up to three children using this one Application form. if number of children are greater than 3, please fill out for the remaining children in separate Application form.
Fee Structure:
One Child = $125/-
Two Children = $225/-
Three Children = $305/-
1st Child's Name*
FirstLast
Date of Birth*
Gender*
- Male
- Female

Student Information
Please Provide 2nd Student information.
2nd Child's Name*
FirstLast
Date of Birth*
Gender*
- Male
- Female

Student Information
Please Provide 3rd Student information.
3rd Child's Name*
FirstLast
Date of Birth*
Gender*
- Male
- Female

Parent / Guardian Information
Please Provide student's Guardian information.
Parent's / Guardian Name*
Primary Email Address*
Note: Provide Email Address that you will use for payment purpose to avoid delays in our response.
Secondary Email Address
Optional
Home Phone*
Work Phone*
Street Address*
City, province, postal code*
More than one Guardian?*
- Yes
- No

2nd Guardian Information
Please Provide student's 2nd Guardian information.
Parent's / 2nd Guardian Name*
Home Phone*
Work Phone*
Street Address*
City, province, postal code*

I give permission for my child to attend virtual summer camp via Google meet.
Parent’s/Guardian’s Signature*
Date*

Registration Fee for One Child is $125/- Review and Checkout to Complete the Registration Process.
Registration Fee for Two Children is $225/- Review and Checkout to Complete the Registration Process.
Registration Fee for Three Children is $305/- Review and Checkout to Complete the Registration Process.
Email
This field is for validation purposes and should be left unchanged.

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