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  • EMYA Registration Form

    If your child is joining us for the first time please complete the full form by saying "Yes", if your child is an existing member of EMYA please complete the short form by saying "No"
  • Todays date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Is your child attending for the first time?*
  • What are you registering your child for?*
  • Date of event, trip, boys or girls club*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Child's date of birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • child's gender*
  • Would you like your child/ren to be walked to the venue by volunteers?*

  • Medical conditions

  • Does the applicant have any long-term illnesses, medical or mental health conditions?*
  • Does the child have any allergies?*

  • Parents/Guardians details

  • Emergency Contact

  • Terms and Conditions

  • 1. To adhere to the principles of Islam and ethos of the Masjid. 

    2. Parent/Guardian must make sure the child brings a spare change of clothes with  them. 

    3. Parent/Guardian must come to collect the child promptly at the end of the  session. 

    4. Parent/Guardian confirm that the child does not have any COVID-19 symptoms. 

    5. Please notify us immediately via email (EpsomMYA@gmail.com) if your child  cannot attend. No refund will be given if cancellation is less than 48 hours before  the event. 

    6. Please ensure that your child is aware of the terms and conditions (See below) for the event. 

    7. By providing your contact details, you consent to EMYA to contact you  regarding any EMYA activities which may concern your child and any other  activities that may be of interest to you. 

     

     

    Terms and Conditions for young person 

    1. Treating each other with respect. 

    2. Welcoming and including new people to Epsom Muslim Youth Association. 3. Being understanding of each other’s differences. 

    4. Not taking photos or making video calls during the event. 

    5. Respect each other’s personal space and boundaries. 

    6. Not swearing or using violent, bullying or abusive behaviour/language.

    These are our priority ground rules but there may be other behaviours not covered  that may require action if Epsom Muslim Youth Association is made unsafe as a result. 

     

     

    WHAT HAPPENS IF THE TERMS AND CONDITIONS ARE BROKEN? 

    If a young person does not adhere to the terms and conditions, it may make volunteers  or young people feel unsafe and if this happens it may be necessary to take the  following actions: 

    1. If a young person breaks the terms and conditions, they will receive a warning from  a volunteer. 

    2. If a young person consistently or seriously breaks ground rules or makes the events unsafe they will be asked to leave that session immediately. Their parent/guardian will  be contacted to collect them and discuss the reason for withdrawal. 

  • Permissions from parent/guardian

    Please tick the boxes you give your consent for!
  • *

  • PAYMENTS

    Please complete payment before submitting the form. We will not confirm your child's place until we receive the money. Payment can be done by bank transfer or PayPal.

  • Payment is £5 by bank Transfer and £5.75 by PayPal. 

    We ask everyone to pay through either of the above methods.

    We will only accept cash from those who cannot pay by bank or PayPal. 

     

     

  • Bank transfer:
    Sort Code: 23-05-80
    Account No: 50887207
    Business Name: Epsom Muslim Youth Association


    Reference: Child's Full Name and Date of Event

  •  

    Pay with PayPal

    Please add your childs full name as reference

  • Have you completed payment?*

  • Please note this form will not submit until you complete payment.

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