TO BE COMPLETED BY EACH INDIVIDUAL RETREAT PARTICIPANT. PLEASE SUBMIT COMPLETED FORMS BEFORE ARRIVAL.

WAIVER OF LIABILITY AND RELEASE

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

PHOTO RELEASE:

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

MEDICAL TREATMENT AUTHORIZATION:

I further understand that, in the event that the participant requires medical or dental treatment while engaged in activities, I hereby consent and give permission to event holders, sponsors, organizers or volunteer to consent to any X-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician; surgeon, or dentist (as appropriate) licensed to practice under the law of the state where the services are rendered, either as an outpatient or in any hospital.