Course Registration

Which Career Camp are you registering for?

ACT Prep Course

Does your child have a laptop they can bring with?

YesNo

Child Name*

First NameLast Name

Parent/ Guardian Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NOTE: There is a $75 fee per child if you live outside of the city of Milwaukee due on the first day.

Phone Number

Area CodePhone Number

DOB*

Date

Gender

MaleFemale

Dietary Restrictions

Allergies, disabilities or medical conditions

Emergency Contact*

First NameLast Name

Emergency Phone #*

Area CodePhone Number

Relationship to Child*

General Authorization

I agree to commit my child to this program under the supervision of the Ma'ruf Center staff and volunteers.I grant the Ma'ruf Center permission to transport my child to and from field trip sites.

Photography/ Media Release Waiver

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Photographic, audio or video recordings may be used for the following purposes:● Informational / training presentations● Social media / marketing / promotion● Informational / training videos● Newsletters or community updates By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in a public setting.I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part services provided by MA’RUF Youth Innovation Center and by MA’RUF Youth Innovation Center’s employees, students, community partners, and consultants. By signing this form, I acknowledge that i have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for promotion, reporting, community sharing, or training purposes.

Parent/ Guardian Signature (If participant is over 18, participant's signature is required)