With Allah’s Name. The Merciful Benefactor, The Merciful Redeemer
THE MOSQUE CARES
2018 Community Hajj Delegation
4816 N. Broad Street, Philadelphia, PA 19141 - Phone: 215-457-8006 Fax: 215-457-7717
www.makehajj.com
est. August 8 – 26, 2018 / Print All Information Clearly; Use the full legal name. / Today’s Date:
!!!FULL NAME BELOW MUST BE EXACTLY THE SAME AS ON YOUR PASSPORT!!!
Full Name: First Middle Last Male Female
AKA: / Date of Birth: Age: Place of Birth:
Home Address: / Nationality:
City: State: Zip: / Occupation: Marital Status:
Home Phone: Cell Phone: / Other’s Traveling with you? How many? ______
Work Phone: Fax #: / Name/Relationship of those traveling with you: (below):
Email address:
Your mothers full maiden name: / Passport#: Exp. Date:
Optional Information Below:
Emergency Contact Information / Masjid Name:
Name: Relationship: / Imam’s Name:
Address: / Address:
City: State: Zip: / City: State: Zip:
Phone: Work#: / Phone:
Medical hardships:
Medications used:
Note: If your passport expires before 2/1/2018, you must apply for a new passport for 2018 travel.
TERMS AND AGREEMENT: The responsibility of AL-MU’ADHDHAN HAJJ GROUP, 4816 Broad Street, Philadelphia, PA 19141, acts as agents and protector for the passengers' rights in making arrangements for the airlines, hotels, buses, or any service in connection with the tour and assumes no liability whatsoever for injury, damage, loss, luggage, accidents, delay irregularity which may be occasioned either by reason or defect, though the acts of GOD, dangerous incidents in the air, sea, land, fire, breakdown of machinery or equipment, acts of government or other authorities de jure or de facto, wars, whether declared or not, hostilities, civil disturbances, strikes, riots theft, pilferage, epidemics, quarantines, medical or customs regulations, or from any loss or damage resulting from improper passports, visas, or other documents. AL-MU’ADHDHAN HAJJ GROUP will accept no responsibilities for loss or additional expenses due to delay or changes in schedule or other causes. AL-MU’ADHDHAN HAJJ GROUP shall not be liable or responsible for any inconvenience, loss, damage or injury arising in connection with such service. AL-MU’ADHDHAN HAJJ GROUP shall not be responsible for the failure to follow instructions, including but not limited to check-in and delay, loss of luggage or personal belongings (Medicine). It is the responsibility of the airline to determine exactly what procedure will be followed. The policy chosen by that carrier shall be based on their procedure and shall not be the responsibility of AL-MU’ADHDHAN HAJJ GROUP and its affiliates. They will also not be responsible for any person (s) missing and part of the program due to his negligence or delay or absenteeism for any time during the tour and will not be responsible for any additional expenses for the participant to rejoin the tour. Moreover, no charges or upgrades in the program chosen will be the honored after departure as well as no refund will be given for any services rendered not utilized. We recommend you invest in travel insurance. Please Note: Once the visa has been issued, no refund can be given.
Please add “X” for package of your choice.4 per room
3 per room
2 per room
Deposit of $1,500 for each person is required to confirm reservation for Hajj / Umrah (circle one) travel.
Full/Final payment due
*Sacrifice fee,Immunization cost, Travel to and from airport (NY,), Travel Insurance, ARE NOT INCLUDED in package cost.
CANCELLATION POLICY: All cancellations must be requested and received in writing (allow two weeks for refund).
Listed Prices do not include: Zabihah (Qurbani) ($150)
Departure , Return . CANCELLATION: CANCELLATIONS made within one week of submitting application are subject to a $250 penalty. Cancellations from seven days after registration date until 90 days prior to departure will be subject to $1000 penalty/person, from 85-40 day prior to departure will be $1500 penalty/per person. Any cancellation received less than 45 days from departure date is non refundable. Any mistake or error in Tour documents issued by or through Al-Mu’adhdhan must be immediately reported to Al-Mu’adhdhan. The failure to give Al-Mu’adhdhan a reasonable opportunity to correct any mistake prior to the commencement of the Tour shall be deemed a waiver of the right to any damages or reimbursement resulting from any such error and the Client will be obligated to pay any additional expense resulting from such error. While Al-Mu’adhdhan is a private company and not associated with any US or foreign government offices or embassies, Al-Mu’adhdhan agrees to follow the rules and regulations of the Saudi Embassy, Ministry of Hajj in Saudi Arabia and the Kingdom of Saudi Arabia.
“I have read and agree with the “Terms and Conditions” above, Deposit ($2,000 minimum per person)
Deposit enclosed: $ ______
I hold harmless the Al-Mu’adhdhan Hajj Group /The Mosque Cares and all its representatives for any acts of irregularity in connection with this travel related with airlines, hotels, transportation, local rules/conditions, Hajj conditions, health-related or other situation(s).” I agree to all the above.
Signature: (English) ______Date ______