Clone of Boy Girls Summer Camp 2026

MASJID NOOR LONG ISLAND

11032 Park Ave, Huntington, NY 11743

feedback@masjidnoorli.net

www.masjidnoorli.net

(631) 683-4185
Registration Form

Date:- ⁠Monday, July 6th - Friday August 14th. 9:00 am - 1:30 pm

Parent Name

First NameLast Name
Father Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Father Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code

Student Name

First NameLast Name
Gender
Date of Birth

MonthDayYear

Name

First NameLast Name
Gender
Date of Birth

MonthDayYear

Name

First NameLast Name
Gender
Date of Birth

MonthDayYear

Name

First NameLast Name
Gender
Date of Birth

MonthDayYear

Select Fee Package

Student Registration Fees

$400.00

Siblings Discount	Quantity	Price
One Child		$400.00
Two Children		$775.00
Three Children		$1,150.00
Four Children		$1,525.00

Item subtotal:

Enter coupon

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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