Program Registration ~ MOHID ©

Dar Al Taqwa

10740 Clarkville Pike, Ellicott City, Maryland 21042, USA

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Registration Open

DAT Summer Camp Week 3 7/21 - 7/25/25

21
JUL

9:00 AM

25
JUL

3:00 PM

Program Fee:

One Time: $180.00

Offering Days: Monday, Tuesday, Wednesday, Thursday, Friday

Reserved Seats: 0/100

1

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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Anything Camp Staff should know about? (allergies, etc)

List any additional drop off/pick up people and their #s

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3

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Dar Al Taqwa consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Since you purchased free Ticket No Payment Required.

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Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Masjid for your and other community member's safety

*Liability waiver:* I, the guardian, state that I am 18 years of age or over and agree to release, waive, and discharge, to the greatest extent permitted by law Dar Al Taqwa and its staff from or for all claims demands and causes of actions of any other liabilities which may arise by virtue of injuries or damages caused in conjunction with or arising out of my child being in the DAT summer camp and agree that I know and understand the risks involved and do hereby assume these risks and accept the responsibility for any damages or injuries that may occur.

*Photo consent:*

DAT camp staff will be taking pictures of campers to be used by DAT for marketing and social media purposes. If you want to opt out at any level, email summercamp@taqwa.net with your camper full names.

Dar Al Taqwa

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DAT Summer Camp Week 3 7/21 - 7/25/25

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Payment Summary

Acknowledgement

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