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Participant's Name
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Participant's Gender
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Participant's Grade Level
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Participant's Phone Number
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Format: (000) 000-0000.
Participant's Email
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Home Address
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Mother's Name
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First Name
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Mother's Phone Number
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Mother's Email
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Father's Name
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First Name
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Father's Phone Number
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Format: (000) 000-0000.
Father's Email
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Does the participant have any allergies?
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Media Release
BEAM Venture Institute has my permission to use my or my child’s photograph publicly to promote BEAM Venture Institute. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensations shall become payable to me by reason of such use.
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Waiver and Release of Liability
I agree that this Waiver and Release of Liability shall apply to each day my child attend's this conference regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises where the conference is being held ; and to the maximum extent of the law, I agree to waive and release any and all claims, suits, or related causes of action against BEAM Venture Institute, their owners, officers, employees or agents for injury, loss, death, costs, or other damages to me, my heirs or assigns, or third party claims suits or related causes of action asserted against BEAM Venture Institute programs or activities arising from my conduct and/or family’s conduct while participating in BEAM’s programs and activities. I further agree to release, indemnify, defend and hold BEAM Venture Institute harmless from any liability whatsoever for future claims presented by my child for injuries, losses, or damages.
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Support the BEAM Venture Programs
Please consider supporting our mission with a donation today. By donating to BEAM Venture Programs, you're investing in the potential of our youth and ensuring that our programs remain free and accessible to all. Your generosity enables us to continue inspiring and empowering young Muslim leaders while keeping our programs and events free of charge.
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