Childcare form

This program is for 4-10 years old. Child must be potty trained.

Please note: This form requires important additional information for childcare. Filling this out does not ensure that your child has a place in the childcare program. You must purchase tickets for childcare.

Buy tickets here: https://muslimfamilycenter.org/store/p/fundraiser

Child's Name

First Name

Last Name

Child's age

Child's Grade

Parent Name 1

First Name

Last Name

Parent Name 2

First Name

Last Name

Parent Phone Number

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Will your child be fasting?

Allergies

Liability and media waiver

In consideration of being permitted to utilize the facilities, services and programs of the Muslim Family Center (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in program, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the facility for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children. The undersigned is aware of the different types of activities, equipment, and facilities offered by the organization, and is aware of the risks inherent in the participation in such activities and use of such equipment and facilities. In further consideration of being permitted to enter the facility for any purpose including, but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the organization, the undersigned hereby agrees to the following: 1. The undersigned on his or her behalf and behalf of such children, hereby releases, waives, discharges and covenants not to sue the Muslim Family Center, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the Muslim Family Center. 2. The undersigned hereby agrees to indemnify and save and hold harmless the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the premises or in any way observing or using any facilities or equipment of the organization or participating in any program whether caused by the negligence of the releasees or otherwise. 3. The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the Muslim Family Center. 4. The undersigned hereby gives permission to Muslim Family Center, to use photographs, voice recordings, or video taken of during the games and events associated with Muslim Family Center in any manner to help promote the activities as determined in the sole discretion of the Muslim Family Center. Such use could include publications, media releases, announcements, electronic or otherwise, and on websites or social media pages. The undersigned understands that neither they nor their child/ward will receive any compensation if such image appears in any of the manners listed above or any other manner that the Muslim Family Center deems appropriate. I agree that such image is the property of the Muslim Family Center. The undersigned further expressly agrees that the foregoing release waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Maryland and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The undersigned has read and voluntarily signs the release and waiver of liability and indemnity agreement, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. I have read and understood this document and release

Yes

No