Men's Retreat - March 18th-20th 2021

Question Title

* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Choose Age to Register

Under 18 ($20.00)

Adult Male ($40.00)

Question Title

* 3. Name of Attending being Registered

Question Title

* 4. I hereby give permission for (Name enter in Question#3) to take part in this Crosby Church event.

Question Title

* 5. Liability and Release Forms, Read and Check All To Agree TO.

Liability:

In consideration of the acceptance of the right to participate, entrants, participants, and spectators by execution of this form, release & discharge Crosby Church, the officers and members of Crosby Church and/or anyone else connected with management or presentation from any & all known and unknown damages, injuries, losses, judgments and/or claims from any causes whatsoever that may be suffered by any entrant to his/her person or property; further each entrant agrees to indemnify all the foregoing entries, firms, persons and bodies from any and all liability occasioned from the conduct of entrants or any participant assisting or cooperating with entrant and under direction or control of entrant.

Media Release:

In consideration of the foregoing event, participant, family and guests agree to permit Crosby Church use of their names, photographs for publicity & advertising (including newspapers, magazines, radio & television) before and after the event, and do hereby relinquish any rights to any such photographs taken in connection with the event, and give permission to publish or dispose of said photographs to Crosby Church.

Medical Care Release:

In addition I give my permission for proper medical care to be given to my son/ or myself by the proper medical authorities in any case as is deemed necessary.

Question Title

* 6. Emergency Contact

Name

Phone Number