Al-Ihsan’s Summer Youth Program

Please fill and submit the form below to register for the summer youth program.

Step 1 of 5

Please select the program you are applying for(Required)

Parent/Guardian Full Name(Required)

First Last

Home Address(Required)

Street Address City State / Province / Region

Parent/Guardian Phone Number(Required)

Parent/Guardian Email(Required)

MEDIA CONSENT FORM AND RELEASE FOR MINORS

During Al-Ihsan's seasonal youth programs and activities, children are occasionally photographed to share their progress and activities with their parents and occasionally post on social media. Please read the media consent below and choose one of the options that follow.
I hereby grant Al-Ihsan Educational Foundation (“Al-Ihsan”), and its agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of My Child, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any Al-Ihsan publication or on the Al-Ihsan social media/ websites, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless Al-Ihsan and its agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
THIS IS A RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING

CONSENT: We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above named child and do hereby give our/my consent without reservation to the foregoing on behalf of My Child.

NON-CONSENT

NON-CONSENT: We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above named child and do not hereby give our/my consent without reservation to the foregoing on behalf of My Child.

Electronic Signature(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your typed name is the legal equivalent of your physical signature on this application.

A significant portion of our youth program consists of both indoor and outdoor activities and sports. The indoor activities take place at the new unit we have recently acquired at our current Al-Ihsan facility, and the outdoor activities take place at the Newton Elementary School playground, located a 6-8 minutes walk away from Al-Ihsan. In order for our children to participate in these activities, we require that you please read the waiver below and include your electronic signature.

Spring Youth Program: Outdoor Activities(Required)

By signing this form, I affirm that I understand that these indoor and outdoor activities may expose my child to some risks and I assume any such risk or injury that may arise therefrom. I accept full responsibility for all medical expenses for any injuries that might occur to my child by reason of his/her participation. By signing this form, I hereby release Al-lhsan, it’s Board members, administrators, directors, officers, teachers, employees, agents, assigns, and volunteers from and against any and all claims, demands, actions, complaints, suits or other forms of liability that any of them may sustain (a) arising out of my child’s failure to comply with local, state, and federal laws and school policies, procedures, and Rules of Conduct; (b) arising out of any damage or injury caused by or to my child during any of these activities or while travelling by foot to and from the designated playgrounds and facilities; or (c) arising out of a parent/guardian/or other designated driver’s operation of a motor vehicle or school bus in relation to this activity. I also agree to indemnify and hold harmless the released parties from the released claims, including any and all related costs, attorney fees, liabilities, settlements, and/or judgments.

I have read and understood the above and allow my child(ren) (those listed in step 2 of this form) to take part in the indoor and outdoor activities at Al-Ihsan and at Newton Elementary School.

Electronic Signature(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your typed name is the legal equivalent of your physical signature on this application.

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Al-Ihsan’s Summer Youth Program

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