medLIM Registration

medLIMS Program

Registration
Parent/Guardian Information
Name*

First NameLast Name
E-mail*
Primary Phone*

Area CodePhone Number
How much students are you enrolling?
Student Information
Student Name*

First NameLast Name
Age
School Name
Grade
Student 2 Information
Student Name*

First NameLast Name
Age
School Name
Grade
Student 3 Information
Student Name*

First NameLast Name
Age
School Name
Grade
Student 4 Information
Student Name*

First NameLast Name
Age
School Name
Grade
Student 5 Information
Student Name*

First NameLast Name
Age
School Name
Grade
Student 6 Information
Student Name*

First NameLast Name
Age
School Name
Grade

Terms and Conditions
The Applicant acknowledges that a non‑refundable application fee of $25 per student is required at the time of submission. Payment of the application fee does not guarantee admission into any medLIMS program. All application fees are final and non‑transferable.

The Parent/Guardian acknowledges that participation in MedLIMS activities may involve inherent risks. By submitting this application, the Parent/Guardian agrees to release and hold harmless MedLIMS, its staff, volunteers, and affiliated partners from any claims, liabilities, damages, or injuries arising from participation, except where prohibited by law or in cases of proven negligence.

I authorize medLIMS to use such photographs, videos, audio recordings, and related media for educational, promotional, informational, and marketing purposes, including but not limited to print materials, digital media, social media, websites, and presentations. If the student, parent, or guardian has a specific concern regarding the use of their child’s image or media, they should notify the Muslim Teen Center directly so that appropriate accommodations can be discussed.

By submitting this application, the Parent/Guardian affirms that they have read, understood, and agree to be bound by these Terms and Conditions. Submission constitutes a legally binding acknowledgment of these terms.
Please Select*

I Agree
Total Application Fee
Please review the names of the students you’re enrolling.
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{studentName253}

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{studentName248}

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My Products*

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

medLIMS Program

Parent/Guardian Information

Student Information

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Student 6 Information

Terms and Conditions