Youth Circle Registration
To register more than one youth, please fill out a separate application for each youth.
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Youth Information
Youth Name
*
First Name
Last Name
Youth Phone Number
*
Format: (000) 000-0000.
Youth Email
*
example@example.com
Gender
*
Male
Female
School Year
*
School Type
*
Public
Islamic
Other
Do you attend any Islamic part-time program?
*
(Weekend or after-school program)
What are your main hobbies and interests?
*
Why are you interested in MAS Bay Area Youth Circles?
*
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Parent Information
First Parent Name
*
First Name
Last Name
First Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
First Parent Email
*
example@example.com
Second Parent Information
Emergency Contact (Please enter contact information for an emergency contact (different than parent) who we can contact in case parents cannot be reached)
*
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Youth Circle
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( X )
Girls Middle School with Sr. Jumana Saleh
$100
$
100
Photo Release Authorization
*
I grant permission for photos or videos taken of me or my child(ren) during MAS Bay Area events/classes/camps/activities to be used on the MAS Bay Area website, in brochures, on social media, and in newsletters for promotional, educational, or informational purposes.
I do not give permission to be photographed, and if I am, I request that my photo not be published.
Liability Waiver
*
By submitting this form, I release and agree to indemnify and hold harmless MAS Bay Area and its officers, employees, agents, and volunteers from any liability, claims, damages, or costs arising from my and/or my child’s participation in MAS Bay Area events, classes, camps, and activities, whether conducted at MAS Bay Area Office or any other sites where such events may take place.
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