Girls Who Lead

Girls Who Lead - Registration Form

Organized by Deen Dunya Learning in partnership with Guildford Islamic Cultural Center (GICC)
Parent's Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Youth's Name

First NameLast Name
Youth's Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
ACKNOWLEDGEMENT AND RELEASE FORM

I, the applicant, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless Guildford Islamic Cultural Centre and Deen Dunya Learning, representatives and agents for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in the Girls Who Lead Program (herein referred to as "the Program") and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Guildford Islamic Cultural Centre and/or Deen Dunya Learning, representatives or agents.

The undersigned acknowledges that:

- He/She is desirous of using, as a registered member, the Program at Guildford Islamic Cultural Centre
- He/She has received a completely executed copy of this agreement.
- He/She confirms that there were no verbal presentations other than those specified in this agreement.
- He/She will be engaged in public speaking, arts and crafts and other similar activities
- He/She may be photographed or filmed while attending the Program and he/she gives permission to Guildford Islamic Cultural Centre, and any affiliates to use any and all photos, video footage, and/or video streaming for promotional, sales, publicity, and advertising purposes for all media including internet.
- The waiver was read and he/she agrees to abide by it.
Date and Time:

Every Sunday

12:00 PM - 1:30 PM SHARP

Location:

GICC Youth Center

14888 104 Ave, Surrey
I agree with the above acknowledgement and release form and give consent to my child to participate

Payment

Girls Who Lead Program at GICC

$100.00 CAD for each month

Enter coupon

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Girls Who Lead - Registration Form

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