Enter information about each person who will attend as a staff member, including parents/adults of campers. Please include the information for other family members attending using the main register page.
	FIRST NAME	LAST NAME	GENDER	GRADE THIS FALL*	AGE AT CAMP TIME	BIRTHDAY (mm/dd/yy)
STAFF ONE			? M F	? PS K 1 2 3 4 5 6 7 8 9 10 11 12 CFR CSO CJR CSN GS PG
STAFF TWO			? M F	? PS K 1 2 3 4 5 6 7 8 9 10 11 12 CFR CSO CJR CSN GS PG
* Indicate the camper's school grade as of this fall (such as 1, 2, 3, . . 12). For children under 5, use the PS code. For college level use: CFR = College Freshman, CSO = College Sophomore, CJR = College Junior, CSN = College Senior, GS = Graduate Student. Parents and Adults in general should use the code PG (Post-Graduate).

	T-SHIRT SIZE?	SHORT OR LONG SLEEVE?	ATTENDED MYC BEFORE?	WHAT YEAR?
STAFF ONE	Select one... Youth XS Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL	Short   Long	Yes   No
STAFF TWO	Select one... Youth XS Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL	Short   Long	Yes   No

	DOCTOR'S NAME AND PHONE	MEDICAL INSURANCE COMPANY AND POLICY #	KNOWN MEDICAL CONDITIONS
STAFF ONE
STAFF TWO

Address:

City:     State:     Zip:

Phone:     Mobile:

Email address:   (Required! We need this to contact you!)

Alternate e-mail address:

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MYC appreciates your participation and support. We are requesting all staff members who are able to do so to pay their way to help MYC cover its financial obligations to the campsite and meet its operational expenses.

Please accept my support in the amount of $295 for the week of camp =
Please accept my support in another amount =
Please waive registration fees for me this year =
Please enter the amounts that you will be paying with your staff registration:
Camp Fees =	$
Zakat or Camper Scholarship Donations =	$
TOTAL Fee and Donation =	$
Amount Paid (50% due with Registration Form) =	$
Balance Due =	$
Make checks payable to Muslim Youth Camp of California

Additional Comments/Important Information: