Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Event: YM Tri-State Retreat Dates: August 20–23 Location: Camp LakotaPersonal 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 *New York EastNew York WestNew Jersey NorthNew Jersey CentralNew Jersey SouthOtherType your Subregion *NN *Shirt Size *XSSMLXLXXLAre you able to drive to retreat? *YesNoNot sureIf you are able to drive, how many can you take in your car legally (including 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?YM Tri-State Retreat— Event Waiver & Release of LiabilityEvent: YM Tri-State Retreat Dates: August 20–23 Location: Camp Lakota⸻This Agreement is made between Young Muslims (YM) and the undersigned Participant (or Parent/Guardian if under 18). It applies to participation in the YM Tri-State Retreat, including transportation, lodging, meals, sports, swimming, recreational activities, halaqas, bonfires, and all related retreat programming.⸻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 Lakota or retreat activities 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 Transportation to and from the retreat may be conducted through carpools, buses, or other YM-arranged transportation.2.2 I understand that participation in YM-arranged transportation is voluntary and at my own risk.2.3 All drivers must be properly licensed and comply with applicable traffic and safety laws.2.4 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 Camp Lakota facilities, lodging accommodations, equipment, and property.3.3 I will disclose any allergies, dietary restrictions, or relevant medical conditions prior to the retreat.3.4 YM will make reasonable efforts to accommodate dietary needs but cannot guarantee allergen-free meals.3.5 I may be held financially responsible for damages caused through misconduct, negligence, or intentional misuse of property.⸻4. Activities & Conduct4.1 I understand that retreat activities may include halaqas, workshops, sports, swimming, bonfires, outdoor recreation, and other group activities.4.2 I agree to participate responsibly, follow all safety instructions provided by YM leadership, and remain within designated activity areas.4.3 I understand that participation in certain activities may be restricted by YM leadership if safety requirements are not met.4.4 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 participation in retreat activities involves inherent risks, including but not limited to slips, falls, collisions, sports injuries, water-related injuries, burns, weather conditions, transportation incidents, illness, allergic reactions, property loss, and other unforeseen hazards.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, allergies, or activity restrictions.6.2 In the event of an emergency, I authorize YM to seek medical care and contact my emergency contact.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 Lakota, 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 where the retreat takes place.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 where the retreat takes place.⸻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 YM Tri-State 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.PaymentPasswordRegistration Cost *Weekend Package - $160.00Registration Cost *Tier 1 (Full Cost) - $250.00Tier 2 (Partially Subsidized) - $225.00Tier 3 (Further Subsidized) - $200.00Financial Aid ApplyFor more details on this contact your NNC.Stripe Credit Card *Participant Electronic Signature (Type your full legal name) *Total$0.00PhoneSubmit