27th National Senior Muslim Youth Camp
Application to be completed by an applicant or parent/guardian aged 18 and over.
Have you previously attended a YMA Camp?
*
Yes
No
Why would you like to attend this camp?
How did you hear about the camp?
*
Facebook
Instagram
Email
Friends
Saturday Madrasah
Sunday Madrasah
Word of Mouth
School brochure
Poster
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Applicant Information
Personal information about the applicant.
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Mobile
*
Student mobile number (Or the best contactable number).
E-mail
*
Student Email Address
Name of academic School / Institute
T-shirt Size
*
XXS
XS
S
M
L
XL
XXL
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Medical
It is essential that staff are aware of any medical conditions your child may have to best cater for them.
Do you have any diagnosed Medical conditions?
*
Yes
No
Please provide details of your medical condition
*
If you are diagnosed with Asthma or Anaphylaxis you are required to bring your medication to the camp.
Please upload a portrait image of the applicant to be used for administrative purposes only
*
Browse Files
Image file should be in jpeg or png format
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of
Do you have any special dietary requirements?
*
Yes
No
Please provide details of your dietary requirements
*
Please upload a portrait image of the applicant to be used for administrative purposes only
*
Browse Files
Image file should be in jpeg or png format
Cancel
of
Medicare Number
*
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Emergency Contact
Information about a parent/guardian/next of kin for the student (must be aged 18 years and older)
Emergency Contact Name
*
First Name
Last Name
Relationship to applicant
*
Mobile Number
*
Emergency Contact E-mail
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Photography & Film Permission
For purposes of documentation, marketing, and evaluation, it is necessary to take photos/videos of participants of the camp. Images may be used for printed publicity, online and social media activities. We will not use the applicant's image without your consent.
Photography & Filming Permission
*
I give photo / film consent
I do not give photo/film consent
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Declaration
By ticking the box below you are agreeing that the above information is correct and you will inform YMA of any changes to details.
To be completed by applicant over 18 years old, or parent /guardian.
*
I agree that the above information is correct.
Comments
Any additional information you would like to provide.
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Fees
Fee includes accomodation, transport, food, activities, camp kit
Payment of fees is a requirement to secure your attendance
*
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( X )
Full fee
(
$
495.00
AUD
for each
year
)
3 x Weekly Installments
(
$
165.00
AUD
for each
week
)
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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