ARISE Registration Fall 2020
A Project of The Multi Cultural Center - EQRA
First and Last Name
Date of Birth
Participant Primary Phone Number
Participant Email address
What do you, the participant, hope to achieve by participating in the ARISE program?
I plan to attend:
Please select which sessions you plan to attend
relationship management (anger management and conflict resolution)
attitudes towards drugs
PARENT / GUARDIAN INFORMATION
Parent First and Last Name
Parent Primary Phone Number
Parent Secondary Phone Number
Parent Email address
PARTICIPANTS UNDER 18 MUST HAVE PARENT OR LEGAL GUARDIAN SIGN BELOW:
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by MAS-MCC-EQRA-ARISE during the selected time period. In exchange for the acceptance of my child’s candidacy by the ARISE Program, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Muslim American Society and its volunteers, facilitators and representatives from any and all liability for injuries to said child arising out of participating in program sessions. ***Due to the fully online virtual nature of this year's program (2020-2021) there are no predicted risks.
I have read and agree to informed consent
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