Seniors Trip 2024

InshaAllah we will be taking a group of seniors to Darlington Provincial Park on Thursday July 11th, 2024.

A full day trip with lots of fun, entertainment, activities, food, and much more!

Registration Steps:

1. Registration link will open on Sunday June 23rd at 12PM.
2. Please do not call for payments once you have successfully registered, you will see instructions in the email.
3. Preference will be given to Durham residents.

Seniors Trip 2024 Registration

First Name *

Last Name *

Gender *

Male

Female

Phone Number *

Email Address *

Confirm Email Address *

Address *

Emergency Contact Name *

Emergency Contact Number *

Is anyone else travelling with you? *

Yes

Relationship *

First Name *

Last Name *

Gender *

Male

Female

Phone Number *

Is the address for this person same as above? *

Yes

Address *

Emergency Contact Name *

Emergency Contact Number *

Liability Waiver Form

In consideration of being permitted to take part in the (Senior's Trip to Darlington Provincial Park) on, (July 11th, 2024) the undersigned hereby irrevocably releases, absolves, indemnifies, holds harmless and waives all claims against (Pickering Islamic Centre) from any liability for personal injury or death in any way related to the participant's participation in the above named Event. Any risk or possibility of injury or death arising out of participating in the Event is voluntarily assumed.

I have read, understood and agreed to the above terms and conditions. *

Yes