Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InfoName *FirstLastEmail *Age *Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease list any allergies we should be aware of. (Type N/A if not applicable) *If you are under 18 and need regular medication, please list below. (Type N/A if not applicable) *Subregion *ConnecticutMassachusetts / Rhode IslandOtherType your Subregion *NeighborNet *BerlinWindsor LocksNew BritainMiddletownNew HavenLowellMetrowestPawtucketSharonQuincyWorcesterOtherChoose the location you go to Halaqah's the most often.Type your NeighborNet *Shirt Size *XSSMLXLXXLIf you are available to drive others, how many people can you drive besides yourself?Emergency InfoEmergency Contact: Name *FirstLastEmergency Contact: Email *Emergency Contact's Phone Number *Emergency Contact: Relation *What is your emergency contact's relation to you?Young Muslims (YM) New England Retreat — Event Waiver & Release of LiabilityLocation: Lake Compounce Amusement Park, 185 Enterprise Drive Bristol, CT 06010This Agreement is made between Young Muslims (YM) and the undersigned Participant (or Parent/Guardian if under 18). It applies to participation in the YM Lake Compounce Trip, including halaqa programming, travel between locations, activities, and meals.1. Participation & Supervision1.1 I understand this event includes multiple locations and activities, and I agree to follow all instructions provided by YM leadership throughout the program.1. 1 I understand that there is an age limit of 15 and above and I am 15 years old or older.1.2 I agree to remain with the group during transitions between locations and not leave any activity without notifying YM leadership.1.3 YM reserves the right to restrict or remove participants for unsafe, inappropriate, or disruptive behavior.2. Travel & Transportation2.1 I understand that the event includes driving between locations, including travel to and from John Wallace Middle School and the food location.2.2 If I participate in YM-arranged carpooling or transportation, I understand that such transportation is voluntary and at my own risk.2.3 All drivers must be properly licensed and comply with all traffic and safety laws.2.4 YM is not responsible for incidents, accidents, or damages that may occur during transportation or outside supervised event areas.3. Activities3.2 I agree to participate responsibly, remain within designated areas, and avoid reckless or unsafe behavior.3.3 I understand that I am responsible for wearing appropriate clothing and footwear for park rules.5. Health & Emergency Care5.1 I affirm that I am physically able to participate and have disclosed any relevant medical conditions, medications, or allergies.5.2 In case of emergency, I authorize YM to seek medical assistance and contact my emergency contact as necessary.5.3 YM is not financially responsible for medical treatment or related expenses.6. Waiver of Liability & Indemnity6.1 In consideration of being permitted to participate, I release and hold harmless Young Muslims (YM), its officers, volunteers, affiliates, and host facilities (including the masjid, school, and food venues) from all claims or liabilities arising out of participation in this event, including injury, illness, death, or property loss6.2 I agree to indemnify and defend YM against any costs or damages resulting from my participation or that of my child.7. Binding Arbitration & Governing Law7.1 Any dispute or claim arising from this Agreement or participation in this event will be resolved by final, binding arbitration before a neutral arbitrator in the state where the event occurs.7.2 I waive any right to a lawsuit, jury trial, or class action.7.3 This Agreement is governed by the laws of the state where the event takes place.8. Acknowledgment of Understanding8.1 I have read and understand this Agreement and sign it voluntarily.8.2 I understand that by signing, I am waiving substantial legal rights, including the right to sue.8.3 If the participant is under 18, I affirm that I am the parent/legal guardian with authority to sign on theirWaiver Acknowledgment & Electronic Consent *I certify that I am 18 years of age or older, or that I am the parent/legal guardian of the participant if under 18. I have carefully read and voluntarily agree to the Young Muslims (YM) New England Retreat — Event Waiver & Release of Liability. By checking this box, I acknowledge that this electronic selection constitutes my legally binding signature and that I am waiving substantial legal rights on behalf of myself and/or the participant.PaymentRegistration Cost *Retreat Registration - $29.00Financial Aid ApplyFor more details on this contact your NNC.Stripe Credit Card *Participant Electronic Signature (Type your full legal name) *Total$0.00PhoneSubmit