Islamic Games All Abilities Basketball
Saturday, June 28th 12:00 PM - 1:30 PM
Caregiver Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender of Participant
Male
Female
Name of Participant
First Name
Last Name
Age of Participant
Disability Of Participant
Autism
Cerebal Palsy
Development Delay
Down Syndrome
Hearing Impairment Including Deafness
Learning Disability
Multiple Disability
Physical Disability
Speech Impairment
Visual Impairment Including Blindness
Other
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 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
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