Young Muslims Midwest Retreat 2023Assalaamu Alaikum!Welcome to YM Midwest Retreat 2K23. Don't miss out on the largest and most anticipated event of the year full of brotherhood, activities, campfires, sports, and most importantly, a chance to get closer to your deen. Register below to receive a confirmation email.Please enable JavaScript in your browser to complete this form.Personal InfoName *FirstLastEmail *Age *Phone Number *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you have any allergies? *YesNoPlease list your allergies below *Subregion *ChicagoKentuckyIndianaOtherOther Subregion: *NeighborNet (Youth Group Location) *Shirt SizeSMLXLXXLEmergency InfoEmergency Contact: Name *FirstLastEmergency Contact: Email *Emergency Contact Phone Number *Emergency Contact: Relation *What is your emergency contact's relation to you?WaiversParent/Guardian Waiver Form (Participant Under 18 years old): I, the undersigned parent/guardian, of the above Participant understand and acknowledge that activities have risks and dangers, that may result in injury, and on behalf of myself, I hereby release and agree to hold harmless Young Muslims, its volunteers, administration, and directors, from all claims, actions, or losses related thereto. Young Muslims assumes no liability for injury, illness or damage arising from the results of participation of the above Participant. The Participant is urged to consult his physician concerning his health to participate. I, the undersigned parent/guardian for the above-named Participant hereby approve of my child’s participation in the Young Muslims NE Retreat 2023 and consent to emergency medical treatment for my child on my behalf. *I accept the above and electronically sign this waiverWaiver Form (Participant Over 18 years old): I, the Participant, understand and acknowledge that activities have risks and dangers, that may result in injury and/or illness, and on behalf of myself, I hereby release and agree to hold harmless Young Muslims, its volunteers, administration, and directors, from all claims, actions, or losses related thereto. Young Muslims assumes no liability for injury, illness, or damage arising from the results of participation of the above Participant. The Participant is urged to consult his physician concerning his health to participate. I, the undersigned Participant hereby approve of my participation in the Young Muslims NE Retreat 2023 and consent to emergency medical treatment.I accept the above statement and electronically sign this waiverLiability Waiver: I hereby approve that if I am seen with, or have possession of, any vape, illegal drug, alcohol, or any other form of medically un-prescribed substance, whether in my belongings or luggage, that I will be immediately expelled from the current retreat (WITHOUT REFUND), will need to arrange transportation myself in leaving, and I will no longer be invited to any future retreats. Furthermore, I hereby approve that I am subject to a search of my bag and personal belongings prior to and during the retreat. I understand that, if caught with any illegal substance, I will be reported to local authorities.I accept the above statement and electronically sign this waiverPaymentPackages *5 Day All Access Package ($200)Stripe Credit Card *Total$0.00NameSubmit
