CAMP Wilayah Registration

Camp Wilayah Registration Form 2022

Step 1 of 5 – Parent

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Parent Infomation

Parent name(Required)





Relation to child(Required)










Ethnicity(Required)

















Address(Required)












Child Information

Child name(Required)





Gender(Required)







DD slash MM slash YYYY
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.If available – clear photo of child’s face.

Child 2 Information

Child name(Required)





Gender(Required)







DD slash MM slash YYYY
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.If available – clear photo of child’s face.

Child 3 Information

Child name(Required)





Gender(Required)







DD slash MM slash YYYY
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.If available – clear photo of child’s face.

Consent(Required)

I give permission for my child to attend Camp Wilayah at Phasels Wood Activities Centre, taking place from 27th August until 31st August 2022; with the following accompanying event leaders in charge: Samir Haidari and Assia Hussain.

● I understand that personal injury can and may occur, and I hereby authorise the above stated event leaders; or another appointed supervisor, to seek and consent to emergency medical attention for my child as needed.
● I also authorise the above event leaders in charge to supervise my child whilst at the camp and to sign waivers for them to participate in activities where necessary.
● I also authorise AIM to film/photograph my child and make this available to the public for the organisation’s marketing or Islamic purposes.
● I release AIM and their volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury that may be sustained by my child while participating in or traveling to and from this event.
● I give permission for my child to ride in any vehicle designated by AIM through its volunteers, while participating in and traveling to and from this event, if such a case arises.
● I accept full responsibility, financially or otherwise, for any damage my child may cause to public or personal property.
● I understand that the organisers reserve the right to send my child home if deemed necessary.












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