Enrollment Form

Emergency Medical Release & Liability Waiver

Agreement

This authorization must be completed before the participant may take part in any program activities. In the event of an injury, medical care will be provided based on the information submitted in this form.

I, the undersigned parent or legal guardian of the above-named participant, understand that participation in the Quranic and Islamic Studies Summer Program hosted by Masjid Al-Haqq involves physical activities and group interaction. I acknowledge that, as with any such activities, there is a potential risk of injury, including but not limited to minor injuries, and in rare cases, more serious harm.

I hereby give permission for my child to participate in all program-related activities and authorize the staff, volunteers, or designated representatives of Masjid Al-Haqq to act on my behalf in the event of a medical emergency. This includes securing medical treatment from a licensed healthcare provider if I cannot be reached in time.

I accept full financial responsibility for any medical services provided and understand that Masjid Al-Haqq does not provide medical insurance coverage for participants.

Furthermore, I voluntarily release and hold harmless Masjid Al-Haqq, its directors, staff, volunteers, agents, and any associated personnel or facilities from any and all liability, claims, or demands arising from my child’s participation in the program, except in cases of gross negligence or misconduct.

I confirm that my child is in good health and physically able to participate. I have read and understood this release and sign it willingly and voluntarily. I also understand that this document may not be modified without written approval from Masjid Al-Haqq and that unauthorized changes may result in my child’s removal from the program.