Youth Brothers Qiyam Night — Registration Form

Participant Information

Full Name *

Please enter the participant's name.

Age *

Must be 16 or older.

Date of Birth *

Please enter date of birth.

Phone Number

Email

Medical Conditions / Allergies

Parent / Guardian Information

Full Name *

Please enter parent/guardian name.

Phone Number *

Please enter a phone number.

Email

Relationship to Participant *

Please select a relationship.

Emergency Contact: The parent/guardian listed above will serve as the emergency contact. Please ensure your phone is reachable overnight.

Rules & Expectations for Participants

Participants must remain on the premises for the entire duration of the Qiyam (after Taraweeh through Fajr). No participant may leave without explicit permission from Shaikh Yasir Khan.
All participants must conduct themselves with adab (proper Islamic manners) and treat everyone with respect.
Foul language, bullying, roughhousing, or disruptive behavior will not be tolerated and may result in immediate dismissal.
Phones must be on silent mode during all prayers and lectures.
Participants must respect masjid property. Any damage is the responsibility of the participant and their parent/guardian.
Participants are expected to actively engage in prayers, lectures, dhikr, and group activities.
No outside food or drinks without prior approval. Suhoor will be provided.
Sleeping areas and restrooms must be kept clean.
Any required medication must be disclosed and brought with parental instructions.
Failure to comply may result in the participant being sent home. Parents will be contacted for immediate pickup.

Parental Consent

I, the undersigned parent or legal guardian, hereby grant permission for my child (named above) to attend and participate in the Youth Brothers Qiyam Night at Brentwood Muslim Community Center on Tuesday, March 17, 2026, from after Taraweeh prayers until Fajr prayers. I understand that my child will be under the supervision of Shaikh Yasir Khan and designated volunteers. I confirm that my child is 16 years of age or older and that the medical/allergy information provided is accurate.

I further acknowledge that my child is not permitted to leave the premises without the express permission of Shaikh Yasir Khan. If my child needs to leave early, I must personally arrange pickup and communicate directly with Shaikh Yasir Khan.

You must agree to the parental consent.

Indemnification, Waiver & Release of Liability

In consideration of my child being permitted to participate, I, the undersigned parent or legal guardian, on behalf of myself, my child, and our respective heirs, assigns, and representatives, hereby voluntarily assume all risks associated with participation in this event.

I hereby release, waive, discharge, and covenant not to sue Brentwood Muslim Community Center, its board members, officers, employees, volunteers, Shaikh Yasir Khan, and all affiliated individuals and entities (the "Released Parties") from any and all liability, claims, demands, or causes of action arising out of any loss, damage, injury, or death sustained during or in connection with this event, whether caused by the negligence of the Released Parties or otherwise.

I further agree to indemnify and hold harmless the Released Parties from any claims, damages, losses, or expenses (including reasonable attorney's fees) arising from my child's participation or any breach of the rules set forth herein.

I acknowledge that I have read this document in its entirety, understand its contents, and sign it voluntarily. I understand that this is a binding legal agreement and that I am giving up substantial legal rights.

You must agree to the waiver.

Signatures

Parent / Guardian Signature *

Sign here

Parent/guardian signature is required.

Parent / Guardian Printed Name *

Please print name.

Date *

Please enter date.

Participant Signature *

Sign here

Participant signature is required.

Participant Printed Name *

Please print name.

Date *

Please enter date.

Brentwood Muslim Community Center