Youth Circle Registration
To register more than one youth, please fill out a separate application for each youth.
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Youth Information
Youth Name
*
First Name
Last Name
Youth Phone Number
*
Format: (000) 000-0000.
Youth Email
*
example@example.com
Gender
*
Male
Female
School Year
*
School Type
*
Public
Islamic
Other
Do you attend any Islamic part-time program?
*
(Weekend or after-school program)
What are your main hobbies and interests?
*
Why are you interested in MAS Bay Area Youth Circles?
*
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Parent Information
First Parent Name
*
First Name
Last Name
First Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
First Parent Email
*
example@example.com
Second Parent Information
Emergency Contact (Please enter contact information for an emergency contact (different than parent) who we can contact in case parents cannot be reached)
*
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Youth Circle
*
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Boys with Br. Suleyman Saib
$200
$
200
Boys with Br. Omar Alnaggar
$200
$
200
Boys with Br. Hamada & Br. Abdarrahman
$200
$
200
Girls Middle School with Sister Fatima Akile
$200
$
200
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Photo Release Authorization
*
I grant permission for photos or videos taken of me or my child(ren) during MAS Bay Area events/classes/camps/activities to be used on the MAS Bay Area website, in brochures, on social media, and in newsletters for promotional, educational, or informational purposes.
I do not give permission to be photographed, and if I am, I request that my photo not be published.
Liability Waiver
*
By submitting this form, I release and agree to indemnify and hold harmless MAS Bay Area and its officers, employees, agents, and volunteers from any liability, claims, damages, or costs arising from my and/or my child’s participation in MAS Bay Area events, classes, camps, and activities, whether conducted at MAS Bay Area Office or any other sites where such events may take place.
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