Cozy Fall Night: Prophet Dawud (AS) Registration

Parent / Guardian Information

Parent / Guardian Full Name *

Phone Number *

Email Address *

Please enter an email address you check regularly. Your registration confirmation and event instructions will be sent to this address.

Number of Children Registering

How many children are you registering? * — Select — 1 child ($24.99) 2 children ($44.99) 3 children ($62.97)

Child Information

Child 1

Child’s Full Name *

Child’s Date of Birth *

Child’s Age *

Allergies, dietary restrictions, medical conditions, or other important information *

Please enter “None” if your child does not have any known allergies, dietary restrictions, or medical conditions.

Does this child carry an EpiPen, inhaler, or other emergency medication? *

No Yes

Please explain what medication your child carries and provide any necessary emergency instructions. *

Is there anything else we should know to help your child participate safely and comfortably? (Optional)

Child 2

Child’s Full Name *

Child’s Date of Birth *

Child’s Age *

Allergies, dietary restrictions, medical conditions, or other important information *

Please enter “None” if your child does not have any known allergies, dietary restrictions, or medical conditions.

Does this child carry an EpiPen, inhaler, or other emergency medication? *

No Yes

Please explain what medication your child carries and provide any necessary emergency instructions. *

Is there anything else we should know to help your child participate safely and comfortably? (Optional)

Child 3

Child’s Full Name *

Child’s Date of Birth *

Child’s Age *

Allergies, dietary restrictions, medical conditions, or other important information *

Please enter “None” if your child does not have any known allergies, dietary restrictions, or medical conditions.

Does this child carry an EpiPen, inhaler, or other emergency medication? *

No Yes

Please explain what medication your child carries and provide any necessary emergency instructions. *

Is there anything else we should know to help your child participate safely and comfortably? (Optional)

Emergency Contact

Please provide an emergency contact other than the registering parent or guardian whenever possible.

Emergency Contact Full Name *

Relationship to Child *

Emergency Contact Phone Number *

Authorized Pickup

Names of all adults authorized to pick up the child/children *

Names of anyone who is NOT authorized to pick up the child/children (Optional)

Photography Permission

Do you give Anas ibn Malik Academy permission to photograph or record your child/children during this event and use the photographs or recordings for school-related marketing, including social media, our website, flyers, and future event promotions?

Yes, I give permission. No, I do not give permission.

Declining photography permission will not affect your child’s ability to participate.

Participation Waiver and Release

I understand that participation in the Cozy Fall Night: Prophet Dawud (AS) may involve ordinary risks associated with children’s activities, including the use of art materials, movement, games, food service, and interaction with other children.

I voluntarily authorize my child/children to participate and accept the ordinary and inherent risks associated with these activities. To the fullest extent permitted by law, I release and hold harmless Anas ibn Malik Academy and its directors, teachers, staff members, volunteers, and representatives from claims arising from these ordinary and inherent risks.

I understand that I am responsible for informing Anas ibn Malik Academy of any allergies, dietary restrictions, medical conditions, behavioral concerns, or accommodations relevant to my child’s participation.

This release does not apply to gross negligence, willful misconduct, or any responsibility that cannot legally be waived.

I have read, understand, and agree to the Participation Waiver and Release.

Emergency Medical Authorization

If I cannot be reached during an emergency, I authorize Anas ibn Malik Academy staff to contact emergency medical services and obtain reasonably necessary emergency care for my child. I understand that I am responsible for any medical expenses incurred.

I understand that academy staff may not administer medication unless the medication, written instructions, and any required authorization have been provided in advance.

I have read and agree to the Emergency Medical Authorization.

Behavior and Safety Policy

Children are expected to follow staff instructions and behave safely and respectfully. If a child’s behavior creates a significant or ongoing safety concern, the parent or guardian may be contacted and required to pick up the child early. Early pickup due to behavioral or safety concerns does not qualify for a refund.

I have read and agree to the Behavior and Safety Policy.

Refund and Attendance Policy

All sales are final. Registration fees are nonrefundable, including in cases of absence, illness, scheduling conflicts, late arrival, early pickup, or failure to attend.

If Anas ibn Malik Academy cancels the event, registered families will be contacted regarding a refund or event credit.

I understand that all sales are final and that I will not receive a refund if my child does not attend.

Electronic Signature

By entering my full legal name below, I confirm that I am the parent or legal guardian of the child/children listed and that I have read and agree to all acknowledgments, authorizations, waivers, and policies above.

Parent / Guardian Full Legal Name *

Date Signed *

Continue to Payment →

Step 2: Review and Payment

Pay and Complete Registration ← Go Back and Edit