Pay for Programs Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Program Name *— Select Choice —Friday Family Night ($5 per week)Riyadh Alssaliheen Sunday SchoolMommy and Me ($20 per month)Amount *TotalPrice: $0.00Email * Card Parent/Guardian Parent/Guardian PhoneParent/Guardian Name *FirstLastChild Name(s) *First and Last Name, AgeMonth *Waiver and Release of Liability Waiver and Release of Liability I, the undersigned parent/legal guardian of the participant named above, hereby acknowledge and agree to the following: 1. Assumption of Risk: I understand that participation in youth activities at the Islamic Center of Bothell (ICOB) may involve certain risks, including but not limited to physical injury, illness, or property damage. I voluntarily assume all risks associated with my child’s participation in these activities. 2. Release of Liability: I hereby release, waive, discharge, and covenant not to sue the Islamic Center of Bothell, its directors, officers, employees, volunteers, and agents from any and all liability, claims, demands, or causes of action arising from my child’s participation in youth activities at ICOB, including those caused by negligence. 3. Medical Authorization: In the event of an emergency, I authorize ICOB staff to obtain necessary medical treatment for my child. I understand that ICOB will attempt to contact me immediately, but if I cannot be reached, I authorize staff to act in my child’s best interest. I agree to be financially responsible for any medical expenses incurred. 4. Photography/Media Release: I grant permission for ICOB to photograph or video record my child during activities for promotional, educational, or archival purposes, including but not limited to social media, website, newsletters, and publications. 5. Code of Conduct: I agree that my child will abide by all rules and regulations established by ICOB. I understand that violation of these rules may result in dismissal from activities without refund. 6. Supervision: I understand that while ICOB staff will provide supervision during scheduled activities, I am responsible for ensuring my child is picked up promptly at the end of activities. CheckboxesI have read and understand the waiver and release of liabilityI authorize emergency medical treatment if necessaryI grant permission for photography/media useI agree to the terms and conditions outlined aboveParent/Guardian Signature * Clear Signature Total$0.00Credit Card *Submit