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?You will be reimbursed for mileageEmergency 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 LiabilityEvent: YM New England Retreat Dates: August 21, 10:00 AM – August 23, 3:00 PM Location: Camp Starfish, New HampshireThis Agreement is made between Young Muslims (YM) and the undersigned Participant (or Parent/Guardian if under 18). It applies to participation in the YM New England Retreat, including all travel, lodging, meals, sessions, recreational activities, and time spent at Camp Starfish.1. Participation & Supervision1.1 I understand that this is an overnight retreat requiring adherence to all YM rules, schedules, and supervision policies.1.2 I agree to remain within designated retreat areas and not leave Camp Starfish without notifying and receiving permission from YM leadership.1.3 YM reserves the right to restrict or remove participation for unsafe, inappropriate, disruptive, or un-Islamic behavior.2. Travel & Transportation2.1 I am responsible for my transportation to and from the retreat unless participating in YM-arranged transportation or carpools.2.2 If participating in YM-arranged transportation, I understand such transportation is voluntary and at my own risk.2.3 YM is not responsible for incidents, accidents, delays, or damages occurring during transportation or outside supervised event areas.3. Lodging, Meals & Facilities3.1 Lodging and meals will be provided during the retreat.3.2 I agree to respect all Camp Starfish facilities, lodging spaces, equipment, property, and rules.3.3 I will disclose any allergies or dietary restrictions in advance. YM will make reasonable efforts to accommodate dietary needs but cannot guarantee allergen-free meals.3.4 I may be held financially responsible for damages caused by misconduct, negligence, or intentional misuse of property.4. Activities & Conduct4.1 I understand the retreat may include halaqas, workshops, group activities, sports, outdoor activities, and recreational programming.4.2 I agree to participate responsibly, follow all safety instructions, and conduct myself according to Islamic morals and YM values.4.3 Possession or use of alcohol, illegal drugs, vape devices, or unprescribed controlled substances is strictly prohibited and may result in immediate removal from the retreat.5. Safety & Risk5.1 I understand that retreat activities may involve inherent risks, including but not limited to slips, falls, illness, allergic reactions, outdoor conditions, recreational injuries, or property loss.5.2 I voluntarily assume all risks associated with participation in this retreat.6. Health & Medical Authorization6.1 I affirm that I am physically able to participate and have disclosed relevant medical conditions, medications, or allergies.6.2 In the event of an emergency, I authorize YM to seek medical assistance and contact my emergency contact as necessary.6.3 YM is not financially responsible for medical treatment, transportation, prescriptions, or related expenses.7. Waiver of Liability & Indemnity7.1 In consideration of being permitted to participate, I release and hold harmless Young Muslims (YM), its officers, volunteers, affiliates, Camp Starfish, and associated facilities or staff from all claims or liabilities arising from participation in this retreat, including injury, illness, death, or property loss, except in cases of gross negligence or willful misconduct.7.2 I agree to indemnify and defend YM against any costs or damages resulting from my participation or that of my child.7.3 This waiver applies to the maximum extent permitted by law.8. Binding Arbitration & Governing Law8.1 Any dispute arising from this Agreement or participation in this retreat will be resolved by final, binding arbitration before a neutral arbitrator in the State of New Hampshire.8.2 I waive any right to a lawsuit, jury trial, or class action.8.3 This Agreement is governed by the laws of the State of New Hampshire.9. Acknowledgment of Understanding9.1 I have carefully read and understand this Agreement and sign it voluntarily.9.2 I understand that by signing, I am waiving substantial legal rights, including the right to sue.9.3 If the participant is under 18, I affirm that I am the parent/legal guardian with authority to sign on their behalf and consent to these terms.Waiver 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 - $165.00Financial Aid ApplyFor more details on this contact your NNC.Stripe Credit Card *Participant Electronic Signature (Type your full legal name) *Total$0.00EmailSubmit