27h National Senior Muslim Youth Camp

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? *

Address *

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 Cancel 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 *

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

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 *

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.

Payment of fees is a requirement to secure your attendance *

Full fee ( $ 495.00 AUD for each year.)

3 x Weekly Installments ( $ 165.00 AUD for each week.)

27th National Senior Muslim Youth Camp