Palos Islamic Center Eid Celebration Registration
Saturday, April 11th I 2PM -4PM
Caregiver Name
*
First Name
Last Name
Are you registered with MUHSEN?
*
Yes
No
If you are not registered with MUHSEN, please register
here
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Number of Adults Attending
*
Number of Children Attending
*
Name of Disability
*
I understand that bringing my family to partake in MUHSEN's event is my decision. I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any activity of any nature. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge MUHSEN and PIC and its officers, directors, employees, agents and volunteers of responsibility. I give permission to MUHSEN to photograph, film, or videotape your child. All pictures/recordings can be legitimately used without any limitation or reservation for reasons of safe and appropriate purposes such as publicity, illustration, advertising, and Web content.
*
Yes, I agree
Submit
Should be Empty: