MYCNJ Summer 24 Program - MAS Youth Center of NJ

Name

First

Last

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Age

Emergency Contact

First

Last

Session Options (Monthly / Weekly)

Monthly
Weekly

Weekly Session Details

Weekly: Session I: June 24th – July 18th

6/24 Week – $180.00
7/1 Week – $180.00
7/8 Week – $180.00
7/15 Week – $180.00

Weekly: Session II: July 22nd – Aug 12th

7/22 Week – $180.00
7/29 Week – $180.00
8/5 Week – $180.00
8/12 Week – $180.00

Do you want to add another 'weekly' child?

Yes
No

Second Child Name – Weekly

First

Last

Second Child Age – Weekly

Weekly: Session I: June 24th – July 18th (2nd child)

6/24 Week – $170.00
7/1 Week – $170.00
7/8 Week – $170.00
7/15 Week – $170.00

Weekly: Session II: July 22nd – Aug 12th (2nd child)

7/22 Week – $170.00
7/29 Week – $170.00
8/5 Week – $170.00
8/12 Week – $170.00

Monthly Sessions

Monthly Session I – 6/24 – 7/18 – $650.00
Monthly Session II – 7/22 – 8/12 – $650.00

Do you want to add another 'monthly' child?

Yes
No

Second Child Name – Monthly

First

Last

Second Child Age – Monthly

Monthly Sessions – 2nd child

Monthly Session I – 6/24 – 7/18 – $610.00
Monthly Session II – 7/22 – 8/12 – $610.00

Child early drop off or late pick up

Weekly late Pick up (3 PM – 4 PM) – $25.00
Daily late pick up – $10.00
None – $0.00

Second child early drop off or late pick up

Weekly late Pick up (3 PM – 4 PM) – $25.00
Daily late pick up – $10.00
None – $0.00

Waiver

Obey code of conduct and comply with Islamic guidelines
Anyone in violation of Islamic etiquette will be given ONE warning. After that, attendee will be asked to leave. No refund will be given
MYCNJ is not responsible for any personal items that are left unattended
Food items may contain allergens. Individuals are responsible for inquiring about possible allergens

Signature

Clear Signature

Coupons and Payments

Coupon

Payment Details

Total

Item Quantity
Qty Total

There are no products selected.

Weekly: Session I: June 24th – July 18th – 6/24 Week 1 $180.00

Weekly: Session I: June 24th – July 18th – 7/1 Week 1 $180.00

Weekly: Session I: June 24th – July 18th – 7/8 Week 1 $180.00

Weekly: Session I: June 24th – July 18th – 7/15 Week 1 $180.00

Weekly: Session II: July 22nd – Aug 12th – 7/22 Week 1 $180.00

Weekly: Session II: July 22nd – Aug 12th – 7/29 Week 1 $180.00

Weekly: Session II: July 22nd – Aug 12th – 8/5 Week 1 $180.00

Weekly: Session II: July 22nd – Aug 12th – 8/12 Week 1 $180.00

Weekly: Session I: June 24th – July 18th (2nd child) – 6/24 Week 1 $170.00

Weekly: Session I: June 24th – July 18th (2nd child) – 7/1 Week 1 $170.00

Weekly: Session I: June 24th – July 18th (2nd child) – 7/8 Week 1 $170.00

Weekly: Session I: June 24th – July 18th (2nd child) – 7/15 Week 1 $170.00

Weekly: Session II: July 22nd – Aug 12th (2nd child) – 7/22 Week 1 $170.00

Weekly: Session II: July 22nd – Aug 12th (2nd child) – 7/29 Week 1 $170.00

Weekly: Session II: July 22nd – Aug 12th (2nd child) – 8/5 Week 1 $170.00

Weekly: Session II: July 22nd – Aug 12th (2nd child) – 8/12 Week 1 $170.00

Monthly Sessions – Monthly Session I – 6/24 – 7/18 1 $650.00

Monthly Sessions – Monthly Session II – 7/22 – 8/12 1 $650.00

Monthly Sessions – 2nd child – Monthly Session I – 6/24 – 7/18 1 $610.00

Monthly Sessions – 2nd child – Monthly Session II – 7/22 – 8/12 1 $610.00

Child early drop off or late pick up – Weekly late Pick up (3 PM – 4 PM) 1 $25.00

Child early drop off or late pick up – Daily late pick up 1 $10.00

Child early drop off or late pick up – None 1 $0.00

Second child early drop off or late pick up – Weekly late Pick up (3 PM – 4 PM) 1 $25.00

Second child early drop off or late pick up – Daily late pick up 1 $10.00

Second child early drop off or late pick up – None 1 $0.00

Subtotal

Total $0.00

Any questions ?

Weekly Session Details

Waiver

Coupons and Payments

ABOUT US

ALL CONTACTS

SUBSCRIBE