Youth Qiyam Registration
Event Timing: Saturday, May 18th, 12:30am-5:00am (technically Sunday)
Event Address: Islamic Center of Irvine 2 Truman, Irvine 92620
Contact Email: yg@icoi.net

DISCLAIMER
ICOI and its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as “ICOI”), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with ICOI and all related activities associated with the ICOI, including injury, loss or damage.

ASSUMPTION OF RISKS
IN CONSIDERATION OF ICOI allowing me or my child to participate in events, activities, or travel with ICOI and all related activities associated with the ICOI, including participation in the Youth Group, and all activities related to the Youth Group (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others.
RELEASE OF LIABILITY and AGREEMENT
IN CONSIDERATION OF ICOI allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child:
1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child’s participation in the Activities.
2. TO WAIVE and RELEASE ICOI from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the activities due to any cause whatsoever.
3. TO INDEMNIFY and HOLD HARMLESS ICOI from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities.
4. TO INDEMNIFY and HOLD HARMLESS ICOI from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities.
YOUTH PARTICIPATION CONSENT
Acknowledgment of Participant:
I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Youth Group, and to obey requests to comply with safety regulations as directed by the persons in charge of the Youth Group, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seat-belt when available and will not disturb or distract the driver when using private or public transportation to travel to and from Youth Group activities. At all Youth Group sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the Youth Group or when using private or public transportation for travel to and from such activities. I also understand that I may be photographed or appear in video for such purposes as ICOI deems necessary.
Acknowledgment of Parent or Guardian of Participant:
We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the Youth Group, including any use of private or public transportation deemed necessary by the persons in charge of the Youth Group for Participant travel to and from Youth Group activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Youth Group activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Youth Group. We also understand that the participant may be photographed or appear in video for such purposes as the ICOI deems necessary.

Email Address of Participant *
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Name of Participant: *
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Age of Participant: *
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Dietary Restrictions/Allergies/Disabilities *
(Indicate Yes or No, if Yes please describe)
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Current Home Address: *
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Emergency Contact Name: (First, Last) *
(Parent/Guardian)
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Emergency Contact Phone Number: *
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Emergency Contact Email: *
Your answer
Signature of Guardian/Parent: *
ACKNOWLEDGEMENT and SIGNATURE: I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by entering my name below and submitting this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.This Consent, Authorization and Acknowledgment shall be effective from September 29, 2017.
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