Girls Qiyam Night Registration
November 14th 2025
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Youth Information
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Gender
*
Male
Female
Age
*
Parent Information
Parent Name
*
First Name
Last Name
Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email
*
example@example.com
Emergency Contact (Please enter contact information for an emergency contact (different than parent) who we can contact in case parents cannot be reached)
*
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I do not give permission to be photographed, and if I am, I request that my photo not be published.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, activities, or transportation provided by volunteers, whether conducted at the MAS Bay Area Office, during transit, or at any other sites where such events may take place.
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