2025-26 Annual Youth Registration

2025-26 Annual Youth Program Registration

OBK Youth is an inclusive organization empowering a diverse group of Muslim American teenagers (ages 13-18) to grow spiritually, socially, academically and professionally through relevant discussions, meaningful community service, and unifying social activities.

To attend our events, each youth (ages 13-18) only needs to complete this annual registration form once per school year.

Parent Information
Parent Name*
Parent Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Same address as youth(s)?*

YesNo
How many youth are you registering?*

1234

Youth Information (1)
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Now (Hidden)

MonthDayYear
Date
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender *

BrotherSister
Is this your first year with the youth group?*

Yes, first yearNo, I've participated in previous years

Youth Information (2)
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Now (Hidden)

MonthDayYear
Date
Gender *

BrotherSister
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is this your first year with the youth group?*

Yes, first yearNo, I've participated in previous years

Youth Information (3)
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Now (Hidden)

MonthDayYear
Date
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender *

BrotherSister
Is this your first year with the youth group?*

Yes, first yearNo, I've participated in previous years

Youth Information (4)
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Now (Hidden)

MonthDayYear
Date
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender *

BrotherSister
Is this your first year with the youth group?*

Yes, first yearNo, I've participated in previous years

Youth Information (5)
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Now (Hidden)

MonthDayYear
Date
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender *

BrotherSister
Is this your first year with the youth group?*

Yes, first yearNo, I've participated in previous years

Liability Waiver
The undersigned does hereby give permission for my child to attend and participate in any OBK YOUTH activities, events, and retreats during the
period of (October 1, 2025 – September 1, 2026)

LIABILITY RELEASE: In consideration of Omar Bin Al-Khattab Islamic Center & OBK Youth allowing the Participant to participate in youth group functions (Activities, Events, Retreats, Lock-Ins, Trips, etc), I, the undersigned, do hereby release, forever discharge and agree to hold harmless OBK Youth and by extension Omar Bin Al-Khattab Islamic Center, its Imams, directors, employees, volunteers and teachers (collectively herein the “OBK”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the youth activities. I, the parent or legal guardian of this participant, hereby grant my permission for the participant to participate fully in youth activities, including trips away from the OBK premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify OBK for any liability sustained by OBK as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by OBK Youth. My child/youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

SICKNESS: Youths who show signs of illness are required to stay home. In the event a child comes to an OBK event unwell, they will be promptly sent home for the safety of other students and staff.
I have read to and agree with the liability waiver (Parent/legal guardian must type in their name)*

Health Conditions/Medications
MEDICATIONS

List all medications the youth will take during any youth trips, retreats, or events. This includes any prescription, non-prescription medications, herbal supplements, and vitamins. Any participant under the age of 18 may, for certain events, be required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medication that they have not alerted us on and will be sent home at the parent/guardian’s expense if they do.
Please list any medication here for the youth you have registered. You can also state that you do not wish to disclose this info
OVER-THE-COUNTER MEDICATION PERMISSION

Do you give permission for your child/youth to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl) while at a youth event?
Over the counter medication permission *

No - Contact me or get medical help if my child has any minor medical concernsYes - I give permission for an adult youth leader to give my child approved over-the-counter medications as directed on an as needed basis to treat non-emergency medical conditions.
Any other pertinent information about the participant (i.e. physical, behavioral, or emotional) that would be important for the adult leaders to know.

OBK Youth Photo Release Form
I agree that OBK Youth may photograph and record my child/dependent’s likeness and activities during (MASJID)-related activities. I grant the following rights to OBK Youth: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the OBK website and on the internet/social media, and worldwide in perpetuity for the purposes stated above.

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge OBK from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have legal capacity to sign the release.
Please select one of the following options*

I approve of pictures being taken during youth events that include my child & being posted on the youth social media and weekly newsletterI disapprove of pictures being taken during youth events that include my child & being posted on the youth social media and weekly newsletter

Parent Information

Youth Information (1)

Youth Information (2)

Youth Information (3)

Youth Information (4)

Youth Information (5)

Liability Waiver

Health Conditions/Medications

OBK Youth Photo Release Form

Program Expectations

Payment Methods