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Islamic Association of Eastern North Carolina

2015-2016 Muslim Youth Group Enrollment Registration Packet

Contents:
Letter to Parents and Youth
Registration and Release Form
Member Rules and Expectations

Dear Parents and Future Youth Group Members,

We are very excited to announce that the 2015-2016 Greenville Muslim Youth Group
program will begin on September 11th InshaAllah. Enrollment is open to all male and
female Muslim youth currently in grades 8-12, accepting 7th graders only if they were in
youth group last year. This years team of counselors includes Br Moahad Dar, Sr Nada
Fadul, Sr Faiza Mustafa, Sr Nowairah Syed, and Br Majde Takieddin. We are all very
excited to have you join us! Joining the MYG provides an excellent opportunity to meet
other Muslim youth, learn about Islamic values, engage in service projects, and learn
how to navigate growing up as a Muslim in America.
This years MYG program details are:
Theme: Uniting the Ummahs Youth
Location: Greenville Masjid Upper Annex
Date/Time: Fridays 6pm-8pm (unless otherwise notified)
1. Cost per child is $100 for the entire year (September 2015-May 2016). This fee
assists us with paying for materials and activities throughout the year. Cash or
checks are accepted. Checks should be addressed to IAENC with subject line: MYG
registration fees and youths name.
2. If after 3 weeks the youth no longer wishes to participate in MYG, the fees are
refunded and the child is no longer able to join the MYG for the rest of the year.
3. Please read and complete the following forms attached in this packet: 1)
Registration and Release Form (2 pages), 2) Member Rules and Expectations.
4. Registration fees and completed forms must be submitted by the first
session on Friday, September 11th. You may email completed forms to us at
greenvillemyg@gmail.com or submit the registration materials and fees to the
collection box located directly in front of the masjid library.
We are very excited to announce this years program, and would just request that you
help with planning and logistics by submitting your registration materials as soon as
possible. If you have any questions or concerns please feel free to email us at
greenvillemyg@gmail.com.
Sincerely,
The Muslim Youth Group Counselors.

Muslim Youth Group Registration and Releases

Program Year: 2015-2016
Islamic Association of Eastern NC
1303 S Evans St. Greenville, NC 27834
Participants Name: ___________________________________________________Participant prefers to be called:
_________________________________
Gender: M or F
Birth Date: ___________________ School: __________________________________ School Grade: __________
Participants Email Address: ____________________________________________________________________
List Any Special Needs/Allergies: ____________________________________________________________________
Parent/Guardians Name: _________________________________________________________________
Home Address: ____________________________________________________________________
Parent/Guardian Phone: __________________________________________________________________
Parent/Guardian email address: ________________________________________________________________
Note: Communication about youth group events will often be done by email. Please list the email that
you check on a regular basis.
In Case of Emergency, please contact:
Name______________________________Relationship__________________Phone_________________________
GENERAL RELEASE:

I understand that participation in the MYG program offered through the Islamic Association of Eastern North Carolina
(IAENC) involves a certain degree of risk. I release the IAENC, youth group counselors, the local council, the activity
coordinators, and all employees, volunteers, related parties, or other organizations associated with the program from any
and all claims or liability arising out of participation in youth group events or traveling to or from said
events. In granting this permission and release, I specifically recognize that my child may from
time to time be transported to events by private vehicles operated by counselors. In such
regard, I specifically release and will hold harmless the IAENC and the Muslim Youth Group
counselors from any and all liability which may arise as a result of such transportation. I have
carefully considered the risk involved and have given consent for my child to participate in the program. I understand
that participation in the program is entirely voluntary and requires participants to abide by all applicable rules and
standards of conduct.
_________________________________________
Participants Name
_________________________________________
Participants Signature

________________________________
Date

_________________________________________
Parent/Guardians Name
_________________________________________
Signature of Parent / Guardian

___________________________________________
Date

Muslim Youth Group Registration and Releases

Program Year: 2015-2016
Islamic Association of Eastern NC
1303 S Evans St. Greenville, NC 27834
MEDICAL EMERGENCY RELEASE:

In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be
reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper
treatment, including hospitalization, anesthesia, surgery or injections of medication for my child. Medical providers are
authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of
medical evaluation of the participant, follow-up and communication with participant's parent or guardian, and /or
determination of the participants ability to continue in the program activities . I understand that it is my responsibility

as the parent/guardian to take care of all financial costs incurred.

_________________________________________
Participants Name
_________________________________________
Participants Signature

________________________________
Date

_________________________________________
Parent/Guardians Name
_________________________________________
Signature of Parent / Guardian

___________________________________________
Date

HEALTH INSURANCE INFORMATION

Insurance Company: ____________________________________________________________________
Policy Holder Name: ____________________________________________________________________
Relationship to Policy Holder: ____________________________________________________________________
Group and/or Policy #: _________________________________________________________________
Primary Physician: ________________________________________________________________
Primary Physician Phone: _________________________________________________________________
PHOTO RELEASE:

The Greenville Muslim Youth Group has a public webpage and a private Flickr account where
photos from youth group events are periodically published. It is our policy that photos of the

youth are tasteful and are never published with names or other identifying information.
Initial one:
________ Yes, you may publish photos of my child.
________ No, please do not publish photos of my child.

Youth Member Rules and Expectations Agreement

By agreeing to become a member of the Greenville Youth Group you are agreeing that
you will abide by following the rules and expectations set by the counselors.
1. Members are expected to come ready to learn and engage in the scheduled
activities to the best of their ability.
2. All Muslim Youth Group members are expected to follow directions given by
counselors without any objection.
3. Members should be on time for sessions and come prepared with writing utensils
and textbook.
4. Members must give counselors a one-week notice if they will be absent or must
leave a session early.
5. Members must attend 8 out of 12 meetings a semester to stay in the program.
6. Members are expected to check all emails in a timely manner and respond
accordingly.
7. Members will behave in proper Islamic and respectful manner at all times.
8. Members must be in the vicinity of the masjid at all times and are not permitted to
leave the masjid during regular Friday sessions unless given permission to do so by
the counselors.
9. Members are expected to dress modestly and appropriately.
10.
Members are not allowed to use their cell phone or other electronic devices
during MYG sessions unless given permission by the counselors. Members must
place their phones in a designated basket for the duration of the session.
11.
Members must maintain proper boundaries with members of the opposite
gender and always be respectful.
12.
Infractions such as (but not limited to): acting out continuously, not following
directions, ignoring counselors will result in disciplinary action deemed suitable by
counselors and/or parental notification.

It is imperative that you read and understand these rules and know that the Counselors
will be sole authority during youth group events.
I, ______________________________ have read and understand the rules listed above. I
agree to abide by all of these rules while I participate in the Greenville Muslim Youth
Group program. I understand that any violation of these rules could result in disciplinary
action as deemed fit by the Muslim Youth Group Counselors.
______________________________________
Youth Signature

______________________________________
Parent/Guardian Signature