I affirm that the above information is complete and true to the best of my knowledge. I verify and agree that my child/self must abide by the rules of the program and must participate fully in the program. I understand that DAH reserves the right to request any participant to leave the program if a participant's conduct is determined to be disruptive to the program and fellow registrants. I understand that the organizing institutions, administration, their officials, and staff are not responsible for any injuries or loss of property that may occur. In the case of an emergency where I cannot be contacted, I authorize the administration to seek medical attention and/or administer any needed emergency procedures for the registrant. I also authorize my insurance information to be used and I authorize Dar Al-Hijrah Islamic Center or the insurance company to release any information required to process the claim. In such a case, I understand that I am financially responsible for any due balance. I understand that my child(ren)/self will not be allowed to begin or continue with the program if payment in full is not submitted prior to the beginning of their first session (or first session of next month).