Page 1 of 2

Madina Masjid Qiyam Night 22nd August Registration

22nd Aug 10.00PM-5.30AM @ Madina Masjid, Barlow Road, Levenshulme M19 3DJ

Brothers only. Ages 11-15. Your spot is only confirmed once payment is received.

Limited spaces available.

Full Name

Participant Age

11+

Can the participant go home alone?

Yes

Emergency Contact Full Name

Emergency Contact Phone Number

Does the participant have any medical conditions or allergies?

Payment

Event Terms & Conditions

• This form must be completed by a parent/carer for participants. • Parents/carers are responsible for drop-off and collection arrangements. • Photos/videos may be taken for mosque use (e.g. social media) • Participants are expected to follow behaviour and safety guidelines. • In case of emergency, medical treatment may be given if required. • Madina Masjid is not responsible for any injuries sustained or loss of items.