Al-Khaadem Youth Camp 2022: Fortitude (Registration Form) (Manual)

"*" indicates required fields

PARENTS' / GUARDIANS' DETAILS

Parents' / Guardian Name*

(as per IC / Passport)

Email Address*

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Relationship with Participants*

Nationality of Participants*

NO. OF PARTICIPANTS

No. of Participants*

#1 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#2 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#3 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#4 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#5 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#6 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#7 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

#8 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#9 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

#10 PARTICIPANT DETAILS

Full Name*

(as per IC / Passport)

Gender*

Male

Female

Age*

Email Address

(eg. example@domain.com)

Phone Number*

(eg. +60123456789)

Country of Residence*

Country

IC / Passport Number*

(eg. 940969713596 / A01234567)

T-Shirt Size*

Allergies / Medical Condition (If any)*

Yes

Allergies / Medical Condition Description*

Additional Notes

OTHER INFO (IF ANY)

Additional Remarks or Notes

PROGRAMME FEES

Price/Participant

Price:

Total Fees

CHOOSE PAYMENT METHOD

Payment Method*

Online Transfer (FPX)

Credit Card/Debit Card (Stripe)

ATM / Bank Transfer (Manual Transfer)

Once payment has been made via Credit Card / Debit Card (Stripe), you may be redirected back to this registration form. Rest assured that the transaction is successful if you received an email of the payment receipt from us.

Emails be marked as spam by your email service provider, so do check your 'junk' folder as the emails may have already been delivered to your email address.

Bank Details (Maybank) Account Number: 5623 5711 4347 "FOQUS AKY SDN BHD"

Proof of Payment*

Max. file size: 128 MB.

Consent*

I agree to all the terms and conditions set forth by FOQUS AKY SDN BHD

By agreeing to the terms & conditions set forth by FOQUS AKY SDN BHD, you have agreed that payment for registration fees made will not be refunded to you in the case of if the participant under your guardianship is not able to attend the Al Khaadem Youth Camp 2022: Fortitude.