Registration

Secure Your Spot

July 31 - August 3, 2026 | Mansfield Outdoor Centre

937365 Airport Rd, Mulmur, ON L9V 3T6

Fields marked with * are required.

Participant Information

Full Name*

Email*

Phone Number*

Date of Birth (DD/MM/YYYY)*

Gender*

Emergency Contact Information

Contact Name*

Relationship*

Phone Number*

If the participant is under 16, please provide parent/guardian details:

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email

Medical Information

Allergies

Medical Conditions

Current Medications

Transportation Information

Do you need carpool?

Room Preference

Who would you like to share a room with?

Optional — if you know the name of the person you would like to share a room with.

Payment Information

Registration fee: $475.00 CAD. Payment will be collected via Interac e-Transfer to finance@mathabah.org. You will receive a unique confirmation code after registering — include it in your e-Transfer message.

Photo / Media Consent

I consent to photographs and videos being taken during the retreat which may be used for future promotional purposes.

Required Agreements

Please read and accept each of the following documents. Click each title to open and review.

I accept the

Assumption of risk, release of liability, and COVID-19 acknowledgment

I accept the

Respectful behavior, modesty, participation, zero-tolerance policy

I accept the

Medical consent, acknowledgment of risks, behavioral expectations

I accept the

How we collect, use, and protect your personal information

Declaration

I declare that the information provided above is accurate to the best of my knowledge. I agree to comply with the rules and regulations of the Divine Connections Retreat.

Participant Signature (type your full name exactly)*

Registration Fee$475.00 CAD

Indeed, in the remembrance of Allah do hearts find rest. (Qur'an 13:28)