Al-Awda Youth Club Registration

Al-Awda Youth Club Registration

Please fill out all blank sections below. Please fill out information for the youth club member (the student joining the club), as well as the information of the parent(s).
Youth Club Member Name*

First NameLast Name
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Youth Club Member Email *
example@example.com
Parent (Emergency Contact) Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Parent Number
Please enter a valid phone number.Format: (000) 000-0000.
Youth Member Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Youth Member School and Grade Level*
Please add anything you would like to tell us about yourself! (Hobbies, Sports, Etc)
By signing below and submitting this registration form, the parent or legal guardian acknowledges and agrees that they are voluntarily allowing their child to participate in all program activities. The undersigned understands that participation involves inherent risks of injury, illness, or other harm. The parent or legal guardian assumes full responsibility for any and all risks associated with participation and hereby releases, waives, and holds harmless Al-Awda PRRC Florida, including its officers, staff, volunteers, and affiliates, from any and all claims, liabilities, or damages arising from the child’s participation, except where prohibited by law.
Printed Parent Name*

First NameLast Name
Parent / Guardian Signature *

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Printed Minor Name*

First NameLast Name
Minor Signature*

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Should be Empty: