YM Dallas End of Year Lock-in

Assalaamu’Alaikum!

YMD will be hosting an all-nighter for all the youth (Brothers 14-25) on Wednesday , December 31st 2025 – Thursday January 1st 2026

For any questions, contact Tanzeel Jaffery – 972-670-9658

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Personal Info

Name *

First

Last

Phone *

Email *

Age *

Which NN are you representing? *--- Select Choice ---EulessCarrolltonValley RanchProsperFriscoEast PlanoRichardson

Do you have any allergies? *

• Yes
• No

Please list your allergies below *

Tournament Sign up

Please select which Tournament you would like to sign up for:Basketball (4 players + 1 sub) - Max 16 teams Soccer (5 players + 2 sub) - Max 16 Teams Pickleball Doubles

Tournament Sign Up *--- Select Choice ---BasketballSoccerPickleballNone

List the Captain and Players Playing (Full Name) *

Example: Basketball - Player 1, Player 2, Player 3 ...

Emergency Info

Emergency Contact: Name *

First

Last

Emergency Contact: Email *

Emergency Contact's Phone Number *

Emergency Contact: Relation *

What is your emergency contact's relation to you?

Waivers

Parent/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 Dallas Lock-In 2026 and consent to emergency medical treatment for my child on my behalf. *

• I accept the above and electronically sign this waiver

Waiver 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 Dallas Lock-In 2026 and consent to emergency medical treatment. *

• I accept the above statement and electronically sign this waiver

Liability 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 event (WITHOUT REFUND), will need to arrange transportation myself in leaving, and I will no longer be invited to any future events. Furthermore, I hereby approve that I am subject to a search of my bag and personal belongings prior to and during the event. 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 waiver

Payment

How would you like to pay? *--- Select Choice ---Cash ($15)CardZelle - (972-469-4368)Cashapp - ($Tmm9772)Venmo - @Taha-Master

Participation Cost *

• YMD Flash Sale - $12.00

Includes Entry ONLY

Participation Cost *

• YMD Cash - $15.00

Includes Entry ONLY

Stripe Credit Card *

Upload Screenshot for payment *

Drag & Drop Files, Choose Files to Upload

Participant Electronic Signature (Type your full legal name) *

Total

$0.00

Phone

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