YM Florida Retreat 2024 (Aug 31-Sep 1)Assalaamu’Alaikum!This year's YM Florida retreat will take place at Camp Geneva in Fruitland, FL during Labor Day Weekend - August 31st through September 1st. Enter Elements of Spirituality! 🌊🔥⛰🍃This weekend will be filled w/ ziplining, campfires, fun, brotherhood, activities, water blobbing, phenomenal speakers, and so much more! Departure details will be provided by your local NN members as the date approaches. For more information contact Ahmed Kasem: (754) 245-5233 or Ahmad Arab: 469-888-2324Please 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 CodeDo you have any allergies? *YesNoPlease list your allergies below *Shirt Size *XSSMLXLXXLWhich Neighbor Net are you from? *SoFloJacksonvillePompanoWest PalmTampaPembrooke PinesMiamiGainesvilleOther/ExpansionPlease write your expansion NeighborNet *Emergency InfoEmergency Contact: Name *FirstLastEmergency Contact: Email *Emergency Contact's 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 FL Retreat 2024 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 FL Retreat 2024 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 waiverPaymentRegistration Cost *YM FL Retreat Early Bird Pricing - $130.00Financial Aid ApplyFor more details on this contact your NNC.Stripe Credit Card *Participant Electronic Signature (Type your full legal name) *Total$0.00CommentSubmit
