BIS Summer Camp 2023 BIS Summer Camp 2023 Registration Form Please fill out a separate form for each child. Event Dates: Week of June 5th Week of June 12th Week of June 19th Week of June 26th (only Monday and Tuesday) Week of July 10th Eid Break: Weeks of June 26th (Wednesday and Thursday) and July 3rd Event Timing: Monday-Thursday from 9:00 AM to 2:00 PM Event Address: HCIC 2524 Hackberry Lane Hoover, AL, USA 35226 And other field trip locations Ages: 6 to 12 boys and girls Price: $100/week per child $50 for the week of June 26th (Monday and Tuesday) If you cannot afford partial or full payment, please continue to complete this form and we will provide financial assistance. Space: Space is limited. We operate on a first come, first serve basis. Your child will be placed on the waitlist if space is full. Please feel free to confirm your status with the below contact information. All information is confidential. Contact Sr. Etaf Saleh at: (205) 446-2917 or etafsaleh1977@gmail.com Camper's Name(Required) First Last Camper's Phone(Required)Camper's Age(Required) 6 7 8 9 10 11 12 Camper's Gender(Required) Male Female What group will your camper be in?(Required) Ages 6-9 Group (boys and girls) Ages 10-12 Boys Ages 10-12 Girls When will your camper be attending?(Required) Week of June 5th Week of June 12th Week of June 19th Week of June 26th (Monday and Tuesday only) Week of July 10th Please select what weeks your camper will be attending from the below choices. $100/week per child ($50 for the week of June 26th) What size shirt does your camper wear? (kids' sizes)(Required) X-Small Small Medium Large X-Large Other Guardian's Email(Required) Guardian's Name(Required) First Last Guardian's Phone(Required)Can your camper eat pizza?(Required) Yes No Does your camper have any dietary restrictions?(Required) None Vegetarian Vegan Other Does your camper have any allergies we need to be aware of?(Required) None Peanuts Fish Other Does your camper have any health issues we need to be aware of?(Required) None Epilepsy Diabetes Asthma Other Does your camper have any medications we need to be aware of?(Required) None Inhaler EpiPen Other Photo Waiver(Required) I consent to the photo waiver.I, the under-named, parent / legal guardian of the above listed participant, hereby give my permission to the Birmingham Islamic Society (BIS), their releases, and to their designated photographer(s) [i.e., counselors, program organizers, etc.], my free and unlimited consent to publish/broadcast, republish/rebroadcast or exhibit in the furtherance of their work, with or without the identification of me or my ward(s) by name, any photographs, videos, or audios of myself/my ward(s), that have been obtained from my/my ward(s) participation in any of the BIS Summer Camp 2023. I furthermore waive any and all claims for any compensation by reason thereof or for damages for reasons thereof.Liability Waiver(Required) I consent to the liability waiver.As inducement to be permitted to participate in the following activity (the “Activity”): Birmingham Islamic Society -Muslim Youth Group Summer Camp 2023 ,I, the undersigned, on behalf of myself, or as the case may be, on behalf of my child(ren) as listed hereinbelow (whether one or more, my “Child”) HEREBY WAIVE AND RELEASE, INDEMNIFY, HOLD HARMLESS AND FOREVER DISCHARGE Birmingham Islamic Society, an Alabama nonprofit association d/b/a Hoover Crescent Islamic Center (“BIS”), and its agents, employees, officers, directors, affiliates, and successors and assigns of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or my Child ever had or may have, arising from, or in any way related to, my or my Child’s participation in the Activity. I and my Child understand that the Activity can be inherently dangerous and may cause serious or grievous injuries, including bodily injury, damage to personal property and/or death. On behalf of myself, my Child, my heirs, assigns, administrators, executors and next of kin, I waive all claims for damages, injuries and death sustained to me or my property or my Child or his/her property, that I or my Child may have against the aforementioned released party to such activity, including claims in tort, contract, equity or otherwise. I and my Child acknowledge, agree, and represent that I understand the nature of the Activity and that I am, and my Child is, qualified, in good health, and in proper physical condition to be involved in the Activity. By this Waiver, I and my Child assume any risk, and take full responsibility and waive any claims of personal injury; death or damage to personal property associated with the aforesaid. Further, I and my Child hereby indemnify BIS against any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that may be incurred by BIS arising from, or in any way related to, the Activity. This WAIVER AND RELEASE contains the entire agreement between the parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties. The provision of this WAIVER AND RELEASE will continue in full force and effect even after the completion of the Activity and termination of the activities conducted by, on the premises of, or for the benefit of BIS, whether by agreement, by operation of law, or otherwise. I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE I and my Child have given up considerable present and future legal rights, and have agreed to do so in consideration of my being permitted to participate in the Activity. I have signed this WAIVER AND RELEASE freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver. I am the parent or legal guardian of my Child.Are you seeking financial assistance?(Required) Not seeking assistance Yes, partial assistance Yes, full assistance Please confirm the week/weeks you are selecting below. First Week(Required) Week of June 5th Second Week(Required) Week of June 12th Third Week(Required) Week of June 19th Fourth Week(Required) Week of June 26th (Monday and Tuesday) Fifth Week(Required) Week of July 10th Summer Camp Partial Payment(Required) Enter whatever amount you’re able to payTotal Credit Card(Required) Card Details Cardholder Name Δ