2nd Annual PNW Summer Dawrah
2nd Annual Pacific Northwest Intensive English Summer Dawrah hosted by Tawhid Islamic Center and MAYF CENTER.
REGISTERATION REQUIRED
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
WhatsApp Number
*
Please enter a valid WhatsApp number.
Format: (000) 000-0000.
Are you over the Age of 18?
*
YES
NO
Age
*
Gender
*
Male
Female
City, State, Zip
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you attending the Dawrah from outside the state of Washington?
*
Yes
No
If Yes, what state?
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Consent Forms
I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THISIS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.
*
I Agree
In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows:
*
I Agree
I HEREBY CERTIFY that I am the parent or guardian of MINOR'S named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
*
I Agree
I hereby read, and agree to MAYF PHOTO USE RELEASE FORM
*
I Agree
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Should be Empty: