MYCC: Girls Youth Halaqah 
2023-2024
Fridays 6:15-7:30PM

*Kindly submit one response per child registered!
Sign in to Google to save your progress. Learn more
Parent/Guardian Information 
Parent/Guardian Name (First and Last)
 *
Parent/Guardian Email Address
 *
Parent/Guardian Phone Number
 *
Student Information 
First and Last Name  *
Age
 *
Student # (if you'd like to be added to our WhatsApp reminder group)
Agreement Section
By selecting "yes" I understand that sessions are from 6:15-7:30PM. 
After 7:30PM, the masjid will not be responsible for the safety/monitoring of your child.
 *
By selecting "yes" I understand that monthly activities may require fees. Attendees will be responsible for paying for activities.

*Costs will be determined and shared with the group in advance.
 *
I hereby give full permission for my child to participate in the Muslim Youth and Community Center Youth Committee's Programs and Activities. I understand that the well-being and safety of my child are of utmost importance to the MYCC's Youth Committee's Programs' organizers, and I, as the listed parent/legal guardian, hereby release the MYCC and any associated youth program organizers and volunteers of any and all liabilities and assume full responsibility in case of any accident or injury before, during, and after the MYCC's Youth Committee's Programs and Activities.
 *
I grant MYCC's Youth Committee organizers, staff, and staff-designated volunteers, as associated with the MYCC, full authority to use their judgment in obtaining and providing emergency medical care deemed necessary to protect the health and safety of my child, at my expense. This care may include, but is not limited to, placing him/her under care of a doctor or a hospital.
 *
I hereby release, hold harmless, and indemnify MYCC and its organizers or agents, either in their individual capacities or by reason of their relationship with the MYCC, from all responsibility, liability, or claims of any nature whatsoever for loss, damage, or destruction of property, or injury due to any cause whatsoever to my family members attending any of the MYCC's Youth Committee's Programs and Activities.
 *
I, the undersigned parent/legal guardian, hereby understand the inherent risks of the programs and activities, and I do, hereby, absolve the MYCC, all of its employees and volunteers, and all of its constituents and associates from any and all liability, actions, causes of action, claims, and demands of every kind and nature whatsoever which I now have or which may arise out of or in connection with my child, named above, participating in any of the MYCC's Youth Committee's Programs and Activities. I understand that the MYCC and the organizers of the MYCC's Youth Committee Program and Activities will be doing their best to mind the safety and security of the participants as a top priority, insha'Allah.
 *
Looking forward to a great year ahead, insha'Allah!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Muslim Youth and Community Center. Report Abuse
Google Forms