Itiqaaf Application

Itiqaaf Application Form

Use this form to apply for a spot in the Ramadan Itiqaaf program at Mountain Masjid. Limited spots are available. Anyone 16 or 17 years of age must be accompanied by a parent AT ALL TIMES and should be included as a dependent on the parent’s application. There are no arrangements for children under 16.

Applicant Information
Applicant must be 18 years of age or older.
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Home Phone*
Alternate Phone
Medical Conditions
Dependent Information
Dependents are youth of age 16 or 17 and must be accompanied by a parent AT ALL TIMES. There are no arrangements for children under 16. Skip this section if you are not registering any dependent.
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
- Male
- Female
Address
Street Address Address Line 2 City Province Postal Code

(If different from above)
Emergency Contact Information
Name*
First Last
Relationship*
Address*
Street Address Address Line 2 City Province Postal Code
Home Phone*
Alternative Phone
Family Doctor*
First Last
Family Doctor Phone*
OHIP Number*
Itiqaaf Days Requested
Request*
- Last ten (10) days of Ramadan
- Night of the 27th of Ramadan to the last night of Ramadan
If you select "Other", please specify which nights you will be staying
Confirmation
Accuracy*
I certify that the details I provided are true and accurate
Acknowledgement*
I agree to the Itiqaaf Rules and Regulations
By submitting this form I agree to abide by the Itiqaaf Rules and Regulations of the Muslim Association of Hamilton.

I will follow all instructions given by the Imam, the Itiqaaf coordinator, a board member, or administration staff of the Mosque.

I acknowledge the MAH does not accept responsibility for any personal injury or loss of or damage to property.

I acknowledge the MAH does not accept responsibility or liability for the wellbeing of participants. I am solely responsible for all costs and expenses in the case of emergency.

I acknowledge failure to abide by the rules will result in immediate termination of Itiqaaf registration and I will be asked to leave the premises.

I acknowledge that the Muslim Association of Hamilton reserves the unconditional right to terminate and/or refuse Itiqaaf registration to anyone at any time without providing reasons or prior notice.

Itiqaaf Application Form

Applicant Information

Dependent Information

Emergency Contact Information

Itiqaaf Days Requested

Confirmation

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