I, the above-named parent and/or guardian, am familiar with the curriculum and the activities of the above-named Program and hereby give consent for the Participant to participate in the Program. I understand that the Islamic Center of Passaic County (the “Center”) makes no implicit or explicit agreement to assume responsibility for the care of any minors participating in the Program, and that all care for said minors remains solely my responsibility. I understand that participation in the Program can include foreseeable and unforeseeable risks and other hazardous activities inherent in the Program, which may expose the Participant to illness, injury or death. 

I convey to the Center all right, title, and interest in any and all photographs, images, video, or audio recordings of Participant or Participant’s likeness or voice made by the Center in connection with his participation in the Program (collectively, “Media”). I acknowledge that the Center may freely use such Media on its website and in connection with marketing of the Program or other Center services.

I state that Participant is free from any known heart, respiratory or other health problems that could prevent Participant from safely participating in any of the activities. I hereby give my express consent in the event of injury, for the Center to obtain for the Participant any emergency aid, anesthesia and/or operation, if in the opinion of the attending physician, such treatment is necessary. I further consent to the search of Participant’s belongings while in the Center to ensure the safety of all in the Program.

I certify that Participant has medical insurance or otherwise agree to be personally responsible for costs of any emergency or other medical care that Participant receives. I agree to release, waive, covenant not to sue, and hold harmless the Center, and all of its officers, employees and agents (collectively the "Releasees") from the cost of any medical care that Participant receives as a result of participation in the Program. I further agree to release Releasees from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of Participant’s participation in the Program. This release extends to any claim made by parents or guardians or their assigns arising from or in any way connected with the aforementioned activities. 

I agree that the site of any lawsuit arising out of or related to participation in the Program shall be New Jersey and that this Agreement will be governed by and construed in accordance with the laws of the state of New Jersey, without application of any principles of choice of law. I shall pay any attorney fees or costs incurred by the Center in enforcing this Agreement. If any portion of this Agreement is held to be invalid by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force and effect. Please initial as an acknowledgement of this statement.