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Parent Infomation
Parent name
(Required)
First
Last
Relation to child
(Required)
Mother
Father
Grandparent
Other
Ethnicity
(Required)
Iraqi
Lebanese
Pakistani
Khoja
Iranian
Indian
Other
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
ZIP / Postal Code
Number of children being registered
(Required)
1 (£225 each)
2 (£195 each)
3 (£195 each)
Child Information
Child name
(Required)
First
Last
Gender
(Required)
Male
Female
Date of birth
(Required)
DD slash MM slash YYYY
Photo of child
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.
If available – clear photo of child’s face.
Does your child attend an Islamic school? if so please specify which
Please inform us of any medical conditions, disabilities, allergies or special needs that your child has
Please provide any details of medications that the child will use during his stay at the camp
Child 2 Information
Child name
(Required)
First
Last
Gender
(Required)
Male
Female
Date of birth
(Required)
DD slash MM slash YYYY
Photo of child
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.
If available – clear photo of child’s face.
Does your child attend an Islamic school? if so please specify which
Please inform us of any medical conditions, disabilities, allergies or special needs that your child has
Please provide any details of medications that the child will use during his stay at the camp
Child 3 Information
Child name
(Required)
First
Last
Gender
(Required)
Male
Female
Date of birth
(Required)
DD slash MM slash YYYY
Photo of child
Accepted file types: jpg, png, gif, pdf, Max. file size: 5 MB.
If available – clear photo of child’s face.
Does your child attend an Islamic school? if so please specify which
Please inform us of any medical conditions, disabilities, allergies or special needs that your child has
Please provide any details of medications that the child will use during his stay at the camp
Consent
(Required)
I agree and consent to all of the below.
I give permission for my child to attend Camp Wilayah at Phasels Wood Activities Centre, taking place from 22nd August until 25th August 2025; 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.
Payment Details
Amount Due
Paid
Tick here if you have already paid
Payment Method
(Required)
PayPal Checkout
Credit Card
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
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