17 Clifton Road, Birmingham, B12 8SX
Tel: +44(0)121 446 6437
Ansaphone: 0121 440 0643
Tuesday, 18 February 2020  
23. Jamadi-ul-Akhir 1441

Masoomin Sports Club - Snowdonia Trip - 4th May 2018

Full Name(*)
Please enter your full name

Mobile Number(*)
Invalid Input

Email Address(*)
Invalid Input

Please state if you have any allergies or medical conditions that we should be aware of
Invalid Input

If you have any special dietary requirements,please enter them here otherwise type none.
Invalid Input

Emergency Contact Name(*)
Invalid Input

Emergency Contact Number(*)
Invalid Input


Choose at least one option

0.00 GBP

I acknowledge that this an athletic event and carries with it the potential of injury and property loss. The risks include, but are not limited to: actions of other people including, but not limited to, participants, volunteers, event officials, event monitors and/or producers of the event; lack of hydration, weather, and/or other natural conditions. I hereby assume all of the risks of participating in this event. I certify that I am physically fit, have sufficiently trained for participation in this event and have not been advised otherwise by a qualified medical person. In consideration of my application and permitting me to participate in this event, I hereby take action for myself and: (A) Waive, release, and discharge from any and all liability for personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, (B) indemnify and hold harmless Masoomin Sports Club from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this event. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by Masoomin Sports Club.
Invalid Input

When you click submit, you will be redirected to Paypal where you can enter your payment information