Ansar Youth Ansar Youth Program Registration Welcome! We’re excited you’re interested in the Ansar Youth Program. This form should take about 5 minutes to complete. Participant Registration FormParticipant's First Name(Required)Participant's Last Name(Required)Age(Required)Please enter a number from 14 to 21.Suburb(Required)This helps us organise carpooling and understand where our participants are coming fromYour Email Address(Required) We’ll send program updates and session reminders hereYour Mobile Number(Required)For urgent updates or communication onlyParent/Guardian InformationRequired for participants under 18Parent/Guardian First Name(Required)Parent/Guardian Last Name(Required)Parent/Guardian Email(Required) We’ll copy parents on all program communicationsParent/Guardian Mobile(Required)Emergency ContactEmergency Contact Name(Required)Someone we can call if we can’t reach you (must be a different person)Emergency Contact Phone(Required)Relationship to Participant(Required)Health & SafetyDoes the participant have any allergies we should know about? Yes No This helps us keep everyone safe during activities and mealsPlease tell us about the allergiesInclude food allergies, bee stings, medications, etc. and what happens if exposedAre there any medical conditions we should be aware of? Yes No Such as asthma, diabetes, epilepsy, heart conditions, etc. This helps us respond appropriately in emergenciesPlease describe the medical conditionInclude any medications taken and what to do in an emergencySwimming ability Can swim confidently Can swim but not confident Cannot swim Prefer not to say We have a swimming session in Month 10. This helps us plan appropriate activitiesProgram ExpectationsWhat are you hoping to gain from this program?This helps us understand your goals and match you with others who have similar interestsWhich areas would you most like to develop? (Select all that apply) Islamic knowledge and spirituality Physical fitness and health Confidence and self-esteem Self-discipline and focus Leadership skills Practical life skills (cooking, budgeting, etc.) Building meaningful friendships Community service and giving back Career and purpose exploration This helps us tailor activities to your interestsHow did you hear about us?Social MediaFriend or FamilyMosque or Community CentreHouse of Sadaqa WebsiteImportant AgreementsPayment I understand the $30 session fee covers coordination and basic materials. Some activities may have additional costs (we’ll give 2+ weeks notice) Medical Consent In an emergency, I give permission for program staff to seek medical treatment and call an ambulance if needed Photo & Video Permission Yes, you can use photos/videos Yes, but please blur faces or don’t tag names No, please don’t include me in photos/videos We occasionally take photos/videos for social media and promotional materialsCode of Conduct I agree to respect others, follow Islamic values of good character (adab), and participate positively in all activities Full Name (Electronic Signature)Type your full name to confirm you’ve read and agree to everything aboveToday's Date DD slash MM slash YYYY Sign Up Fee (includes first session) Price: Credit Card
