Qiyam Night Registration Form

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Youth Full Name *

First NameLast Name
Youth Age*
Youth Phone Number*
Please enter a valid phone number.
Youth Email*
example@example.com
Any allergies or medical concerns?*
Would you like to be notified about upcoming programs/events at the Ranchlands Musallah*

YesNo
I hereby grant full media consent to be photographed or videotaped for the purposes of social media marketing. I understand these images and videos may be used in promotional materials on various social media platforms. This consent covers all related activities aimed at promoting the event and the organization.*

YesNo
Where did you hear about us?*

Social MediaEmailWord of MouthFlyerOther

Payment
Use the following link to pay the fee for this program, AND UPLOAD A SCREENSHOT OF THE RECEIPT BELOW.

SIGNING UP WITHOUT PAYMENT DOES NOT CONFIRM A SPOT.
Please upload a screenshot of your payment receipt below. *

Cancelof
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HS & Uni Brothers' Qiyam Registration Form