Girls Group

Registration for Girls Group 2021-22

* Indicates required field

Primary Contact Email *

Primary Contact Number *

Guardian/Emergency Contact Name *

Guardian/Emergency Contact Number *

Preferred form of payment: *

Paypal Check (written to FIC)

Name Participant #1 *

First

Last

Grade Participant #1 *

Allergies Participant #1 *

Name Participant #2 *

First

Last

Grade Participant #2 *

Allergies Participant #2 *

Name Participant #3 *

First

Last

Grade Participant #3 *

Allergies Participant #3 *

In consideration of the risk of injury while participating in Girls Group, on November 5, 2021 - May 25, 2022 (the “Activity”), and as consideration for the right to participate in the activity I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims are causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge the Islamic Center of Flint (“FIC”), their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns, for any physical or psychological injury, included but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I am voluntarily participating in the aforementioned Activity and I am participating in the Activity at my own risk. I am aware of the risks associated with traveling to and from as well as participating in the Activity which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity. I agree to indemnify and hold harmless FIC against all claims, suits or actions of any kind of whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If FIC incurs any of these types of expenses, I agree to reimburse FIC. I acknowledge that FIC and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party of entity conducting a specific event or activity on behalf of FIC. I acknowledge that I have carefully read this “waiver and release” and fully understand that this is a release of liability. In the event that I should require medical case or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any provision contained within this Release of Liability shall be deemed severable or invalid, or if any term, condition, phase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. By choosing ‘Agree’ and electronically submitting, I certify that I am the guardian of any and all participants or am 18 years or older and guardian of all listed participants. *

Agree

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Girls Group​2021-2021

​Registration for Girls Group 2021-22

Girls Group
2021-2021

Registration for Girls Group 2021-22