Participant Application

Pre-Eligibility Questions

Please fill out the questions below to determine if you meet our eligibility requirements
How old are you?*
What is your current education status?*
Please pick the one which closely relates to you.
Where do you live?*

I live in Tucson, Arizona.I live somewhere else.
How did you or your parents arrive to the United States ?*

We arrived as refugeesMe or my parents came to the US as immigrants (non-refugee)I was born in the USI don't know
What language do you speak at home?*

At this time, you don’t meet our basic requirements to be a Hasanaat member. We have determined this based on the answers to the questions on the previous page. We continue to expand our eligibility so please check back in a few weeks to determine if you meet the requirements.

Please know, providing false information on your application will result in automatic expulsion. Please make sure you answer honestly.

If you feel you received this message in error, please email us at hasanaat@hasanaat.org.

On the next page, the application will begin. It will take about 10 minutes to complete the application. Here is everything you need to be able to complete your application.
- Participant/Student information
- School ID or Permit/Driver’s License or Screenshot of StudentVue
- A Parent or Guardian (to agree to Hasanaat’s program agreement and waver)
- Allergy/Medication information
- Emergency Contact

Participant Information

On this page, please provide information is for the student who is applying to join the Hasanaat program
Participant Name*

First NameLast Name
Gender

MaleFemale
I have a:*

Cell PhoneEmailFacebook Profile
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What is your Facebook user name? (you'll be invited to join our Facebook page)*
What country are you originally from?*
Please provide the country you are from*
What is you or your family's faith background*
This is the religion you or your family practices. We use this information to make sure we ensure our center respects and accommodates your beliefs.
What is the religion you practice? *
What year did you or your parents come to the United States?*
Date of Birth (Birthday)*

MonthDayYear
Date
What school do you attend?*
Please take a picture of your School ID, Driver's Permit, Drivers License or SudentVue screenshot of the "Student Info" page.*

Parent/Guardian Information

Please provide the information below for the legal guardian for the participant. This person will serve as the emergency contact.
Parent Name*

First NameLast Name
Relationship to participant*

MotherFatherLegal Guardian
Parent Phone Number:*
Please enter a valid phone number.
Parent Email Address:*
example@example.com
Should the person listed above serve as the emergency contact?*

Yes, the person above is the emergency contactNo, someone else should serve as my emergency contact
Emergency Contact Name*

First NameLast Name
Relationship to participant *
What is your relationship to the participant? *
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com

Liability Waver (to be completed by a parent)
Parental Consent

The undersigned does hereby give permission for their child (“Participant”), to attend and participate in any Hasanaat Incorporated programs, sessions, activities, events, sports, or retreat (collectively known as “activities”).

LIABILITY RELEASE: I, the undersigned, do hereby release, forever discharge and agree to hold harmless Hasanaat Incorporated, its owners, directors, employees, volunteers and teachers (collectively herein the “staff”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the activities. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in the activities and care, including trips away from the Hasanaat Incorporated premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify Hasanaat Incorporated for any liability sustained as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

MINOR RELEASE POLICY: I, the undersigned, do hereby understand and agree that it is not the responsibility of Hasanaat Incorporated to care for Participant once they leave the facility without permission or in the care of an adult. Hasanaat Incorporated understands Participant make take public transportation to arrive and leave the facility. Once they leave the premises, Hasanaat Incorporated assumes no responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for Participant to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Hasanaat Incorporated. My Participant and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

By signing below, I agree that I have read this release of liability and assumption of risk agreement, fully understand its terms, and agree to have my child become a Participant.
Parent Printed Name*
Signature*

Clear

Illness and COVID-19 Waiver (to be completed by a parent)
WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate in Hasanaat Incorporated’s program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1.     Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2.     I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3.     I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4.     I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Hasanaat Incorporated their directors, employees, volunteers, teachers, other participants, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

By signing below, I agree that I have read this release of liability and assumption of risk agreement, fully understand its terms, and agree to have my child become a Participant.
Parent Printed Name*
Signature*

Clear

Photo Release Form (to be completed by a parent)
I agree that Hasanaat Incorporated may photograph and record my child/dependent’s likeness and activities during program related activities. I grant the following rights to Hasanaat Incorporated: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the Hasanaat Incorporated website and on the Internet, and worldwide in perpetuity for the purposes stated above.

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge Hasanaat Incorporated from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 18 and have legal capacity to sign the release.
Parent Printed Name*
Signature*

Clear

Expectations to Participate (to be completed by a parent and participant)
Expectations

While participating, Hasanaat Incorporated participants shall...
- Respect the individual rights, safety, and property of others.
- Avoid displays of overly affectionate behavior.
- Not participate in obscene and/or discriminatory language or roughhousing.
- Not be insubordinate to chaperones or the staff in charge .
- Not possess or use weapons, alcoholic beverages, tobacco and/or illegal drugs at any event, activity, or meeting, or remain in the presence of individuals who possess or use these items.
- Abide by all rules of the attended event, activity, or meeting.
- Participate in activities to the best of their ability.
- Not leave the center without permission.
- Not behave in a manner that violates any of the laws of the United States or the State of Arizona or any local ordinance.
Disciplinary Action

Disciplinary action penalties and/or disciplinary action for infractions of this code of conduct may include any or all of the following:
- Sending participant home.
- Barring/terminate that participant from future Hasanaat Incorporated activities.
- Being held responsible for the cost of damages and repairs in the event of damage/destruction of property.
- Release of the youth to the nearest law enforcement agency and/or the proper authorities for significant violations of law.
Rewards and Incentives

Hasanaat Incorporated’s program may provide incentives, financial rewards, gifts or cash to participants. These rewards are not guaranteed and are may be canceled/discontinued or postponed at any time for any reason. Hasanaat Incorporated staff and leadership at their discretion select the participants who receive the incentives and the allotted amounts. Rewards and incentives are not to be considered payment for labor or services.

Academic Grades and School Behavior

During your time at Hasanaat Incorporated’s program, leaders will request students to see their grades and teacher comments. Grades/comments are used to determine academic success and determine if academic goals are met which provide incentives. Failure to present grades, falsifying grades or showing incorrect/old grades can result in suspension or removal from the program.

Right to End Participation

I, the undersigned, agree and understand that both Hasanaat Incorporated and/or parents of the participant may terminate the participant status at any time, for any or no reason - with or withouit notice.

At the point of termination, nothing will be expected from either party unless otherwise outlined in the agreement. This may include the cost of damages and repairs in the event of damage/destruction of property.
Parent Printed Name*
Parent Signature*

Clear
Participant/Student Printed Name*
Participant/Student Signature*

Clear
Should be Empty:

Pre-Eligibility Questions

Participant Information

Parent/Guardian Information

Health /Food Allergy Assessment

Liability Waver (to be completed by a parent)

Illness and COVID-19 Waiver (to be completed by a parent)

Photo Release Form (to be completed by a parent)

Expectations to Participate (to be completed by a parent and participant)